First Aid Journal 1954-1957 by Museum of the Order of St John

PRICE FlVU'ENCE 3/3 ,... Ana.. Free

'OIl

bactericidal thus obviating the need, when not convenient, of changing the dressings every day.

SKIN INFECTIONS are primarily caused by Staphylococci, Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these m·icro-o~gan. isms.

FOR CUTS, ABRASIONS, BOILS and numerous skin infections, A TIPEOL is llnquestionably the remedy. It is already in widespread use by the medical and nursing professions in many parts of the world.

A TIPEOL CUTANEOUS OINTMENT is a prepara-

tion which incorporates the sterile broth filtrates of the three infective microbes in an ointment base of proved efficiency further to accelerate the process of rapid healing. AS

TREATMENT

ANTIPEOL is therefore

an essential component of every First Aid and Nursing Kit.

for burns and scalds,

ANTIPEOL OINTMENT is both non-adhesive and

antipeo cutaneous ointment

Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTJPEOL for nasopharynx infections; OPHTHALMO-ANTlPEOL for ocular infections; DETENSYL for reducing arterial tension. MEDICO-BIOLOGICAL LABORATORIES LTD., CARGREEN RD., SOUTH NORWOOD, S.E.2S

FIRST AID & NURSING, JAN.JFEB. 1954

MEN'S UNIFORMS and LADIES~ GREAT ~OATS & ~OSTUMES for Divisions of the St. John Ambulance Brigade can be obtained from

First Aid &

Nursing Jan. /Feb. 1954

In this Issue

D OBSON & SONS (London)

Place of the first-ai derin industry

UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS LONDON BRIDGE S.E.1 154 - 164 TOOLEY STREET

Editorial

Notes on advanced physiology

Casualties Union

Industrial first aid: coal mining

Conquest of diphtheria

R ed Cross competitions: County of Sussex

Readers' queries

First-aider's crossword...

'Grams:

' Phone : Hop 2476 (4 lines)

Fractures of individ ual bones

"Hobson, Sedist, London"

PATENT

"PORTLAND" AMBULANCE GEAR The Gear illustrated(A.B.C.D.) carries two stretche rs on one side of Ambulance, leaving other side clear for sitting patients. The UP AND DOWN action is qUick and easy for loading or unloading .

no you know that • •• The eyelids of a person poisoned by ivy may swell to the size of a tennis ball ?

A. Shows the two stretchers in position. B. Shows the top stretcher lowered ready for loading. C. Illustrates t he same Gear with t he top stretcher frame hinged down for use when only one stretcher case is carried . D. Shows the sam e position as in I t C ' only with cushions and back rest fitted for convalescent cases.

Where Ambulances are"'~quired to carry four beds two Gears are fitted, one on EITHER SIDE, and the same advantages apply as described above. FuJI cata logue of Ambulance Equipment N o. 7A wi/I be sent on requ est .

65, WIGMORE STREET, LONDON, W.I ' Phone: WELbeck 0071 (Late GREAT PORTLAND STREET)

Strong emotions such as anger or excitement may cause a rise in blood-pressure by constricting the blood-vessels ? The fingers should never be allowed to come into contact with the edges of a drinking vessel from which a patient has drunk ? The normal body temperature of some healthy persons is 97.4 OF ., a full degree below that usuall y quoted ? Pitch and tar can be removed from fabrics by the use of benzine ? The quantity of blood in an individual is said to be one pint less than the number of stones he or she weighs ?

The Place of the Nurse and FirstAider in Industry · By Agnes Pavey S.R.N., Diploma in Nursing (Lond. Univ.) FROM the economic as well as the humanitarian standpoint all heads of industrial organizations now realize that the health, happiness and general well-being of the workers are of primary importance to the success of the industry, and, in order to achieve these ends, the departments of Labour M anagement and of Industrial H ealth must each have efficient personnel with adequate freedom of action. The Industrial H ealth Department, in those organizations where such a department exists, is responsible for ascertaining the physical fitness of all new employees for the job they are required to do, for ensuring the best conditions for sustaining health, for recognizing early signs of physical or emotional stress, and for seeing that the conditions of work are such that the liability to accidents is reduced to a minimum. All this is concerned with the prevention of illness and accidents, and, although much important work can be done in this sphere, sudden illnesses will occur and accidents will happen from time to time; so that the Health D epartment must be staffed and equipped to deal with treatment and with first aid at any time when this becomes necessary. It is not, however, economically possi ble for the smaller ind Lrtrial organizations to have a Health D epartment, and yet their obligations to the workers are as important as those of the larger business concerns, and they must be met. Then again, many workers are employed outside the office or the factory, for example, in the building trades and in agriculture. They also need first aid and medical care from time to time, and provision must be made for the necessary services to be available. How are these services planned to meet the needs of workers in various situations, and what part can the trained first-aider play in bringing about their efficiency and success? In the first place, some considerations must be given to the legal obligations of employers with regard to their workers, and then to the means whereby these obligations may be fulfilled; for it is against this background that the work of the first-aider and the industrial nurse must be organized. Industrial Legislation Since 1819, when the first Act was passed which reduced the working hours of children in cotton facrories to twelve a day, numerous Acts ofParliament.l~ave been passed to control working condItIons and generall y better the lot of industrial employees; but we are concerned mainly with the provisions of the Factories Acts of 1937 and 1948 as they affect health, safety and welfare. The first of these consolidated and amended the provisions of previous Acts, and the latter extended certain sections a nd transferred powers from the Secretary of State to the Minister of Labour; who is now responsi ble for enforcing. all re~u lations made under the Act. Duties relatmg to the hea lth and safety of out-workers are, however the responsibility of D istrict Council; and these Councils must keep a record of all factories within their districts. A ' Factory' is defined as premises wherein

persons are employed in manual labour incidental to the making of any articles, or in altering, cleaning, repairing, ornamenting or finishing any article, or adapting it for sale. So that laundries, gasworks, packing rooms, film studios, garages, printing works, shipyards and dry docks also come under the Factory Act. Conditions at aerodromes are controlled by Public Health (Aircraft) Regulations (1950), and on ships by Port R egulations (1933 and 1945) and the Merchant Shipping Acts (1948 and 1950). P rovisions of the Factories Act Nurses and first-aiders in industry must be acquainted with the main provisions of the Act controlling the particular organization in which they are working. Briefly, Part I of the Factories Act defines acceptable standards of cleanliness, temperature, ventilation and lighting for all factories, the cubic space requirements to prevent overcrowding, the drainage of floors where wet processes are carried on, and the provision of adequate sanitary conveniences. The Minister of Labour is empowered to make special regulations requiring medical supervision (not including medical treatment other than first aid and medical treatment of a preventive character) of persons employed in any factory where it appears that (a) cases of illness have occurred which may be due to the nature of a process or other conditions of work, (b) by reason of changes in any process or the introduction of any new process, there may be risk of injury to the health of persons employed, or (c) young persons are, or are about to be, employed in work that may cause risk of injury to their health. Part IT deals with safety precautions, such as fire escapes for those working above ground-floor level, protection against dangerous fumes and inflammable gases, vapour or dust, and the safety of machinery. Part lIT is devoted to Welfare, and it is this part with which we are mainly concerned, for it contains the regulations regarding the provision of adequate first aid equipment and personneL A first aid box or cupboard of the prescribed standard must be provided, and where more than 150 persons are employed there must be an additional box or cupboard for every additional 150, any fraction of 150 being reckoned as 150. Every first aid box or cupboard must be under the c.harge of a responsible person who must, in the case of a factory where more than 50 persons are employed, be trained in 'first aid treatment. The person in charge must always be readily available during working hC!urs and his or her name must be affixed m every workroom. The recognized first aid training is that of the St. J ohn ~bulance Brigade the British Red Cross SOCIety, the St. Andrew Ambulance Association , the Police or one of the armed services. Other sections of Part III deal with the provision of adequate supplies of wh?lesome dri nking water, convemently accesSIble washing facilities, accommodation for clotI:ing not worn during working hours and, If (continued in column 2, page 3)

FIRST AID & NURSING, JAN./FEB. 1954

~OURSE

IN ELEMENTARY FIRST AID

Fractures of individual bones By A. D. Belilios M.B. , B.S. (Lond.), D.P.R. (Eng.)

IN ofprevious articles: the principles fractures have been discussed. This month it is intended to give a brief description of the more important symptoms and signs of fractures affecting individual bones in the body. There is no object in discussing treatment since this should be adequately dealt with in the practical work which the student undertakes. Broken Nose This injury was formerly considered to be of little consequence and indeed one of which to be proud. It is usually sustained in sport and due to direct violence such as a blow. Nose-bleeding and pain may be the only symptoms but swelling and bruising are often present. Sometimes the nose is obviously deformed and out of shape. But the first-aider must never forget that in a great number of fractures, tenderness is the only sign and if discovered a diagnosis of fracture must always be made. Apart from the disfigurement that results from a broken nose internal injuries, e.g., displacement or fracture of delicate bones within the organ are not uncommon. The result may be permanent impairment of function which can only be righted partially or completely by operation. It follows, therefore, that a broken nose should be regarded as a potential serious injury and should be referred to a doctor or hospital. The first aid treatment consists of relieving pain by applying cold compr~ss~s and, in generaL adopting the pnnclples for nos(}-bleeding. Fractures of the Bones of the Face A number of bones fOlm the framework of the face. They are not usually taught to first-aiders and are not common as fractures. Nevertheless a fracture of the bone of the cheek or the arch of bone leading

backwards from it towards the ear (zygomatic arch) may occur and are the result of direct violence. Pain, tenderness, swelling and bruising are the chief symptoms and signs; sometimes the deformity shows itself as a dent in the side of the side of the face. There is little to be done by way of first aid treatment, everything depends on diagnosis or, at any rate, suspecting a fracture. The surgical treatment for cases of this kind is often complicated since it is very important to reduce the fragments into r.. good position. Fractures of the skull are more appropriately dealt with in a subsequent article. Fracture' Jaw This can be an unpleasant injury particularly when it is caused by severe violence. The fracture may be compound or complicated. In the latter event, the gum may be torn, the muscles of the tongue disorganized and severe bleeding present. In all fractures of the jaw the usual symptoms and signs are present with slight modification. Thus the patient has difficulty in speaking and swallowing. There is swelling, deformity and tenderness along the course of a bone. On examination in the mouth, irregularity of the teeth is often found together with a wound of the gum. There is often a profuse flow of blood-stained saliva from the lips. Important complications include slipping of the tongue into the back of the throat when it may cause asphyxia; the latter may also be due to clotted blood. In any event blood may be swallowed and later vomited. Broken Ribs These are common injuries. Usually the middle pairs of ribs are

affected, i.e., the 6th, 7th and 8th pairs. The usual symptoms and signs of a fracture may be absent but certain characteristic features make the diagnosis of broken ribs comparatively easy. The patient complains of a severe stabbing pain in the side of the chest; this is worse on taking a deep breath or on coughing. It will be noticed that the breathing is cautious and restricted; the patient avoids, as far as possible, taking a deep breath. All that is necessary by way of further examination is to detect the rib that is probably broken and this is easy since the first-aider will be guided to the situation by the patient's own feelings and , of course, by determining the situation of the tenderness. There is no need whatever to conduct an exhaustive examination in a case of this kind particularly since the common signs of a fracture such as deformity, swelling and irregularity will be absent. J njury to the lung, not an uncommon complication, causes obvious shock. There is often shortness of breath and difficulty in breathing; moreover frequently the patient coughs up blood which is bright red in colour and frothy, An occasional complication of injury to the lung is called surgical emphysema. In this event air finds its way into the fat under the skin of the chest, producing an obvious swelling which when touched appears to give a feeling rather like' egg shell crackling.' In bad cases, this swelling may be very extensive, even making its appearance under the skin of the whole of the chest and abdomen or even up to the neck. Fractured Sternum This uncommon injury is accompanied by pain, tenderness and slight swelling over the bone. Movement

FIRST AID & NURSING, JAN. jFEB. 1954

of the chest is painful and in bad cases there. may be shortness of breath. It should never be forgotten that a fractured sternum is not infrequently associated with a fracture of the spine in the thoracic region. In other words, a fractured sternum usually results from a severe accident. Fractured Scapula This again is an uncommon accident and the injury is often accompanied by damage to other bones and parts of the body. There is pain, swelling and tenderness over the affected bone. Moreover any attempted movement of the arm tends to increase the pain. Fractured Clavicle This is a common injury and can often be diagnosed on the history alone. The story is one of indirect violence, i.e., a fall on the hand or shoulder followed by severe pain in the lower part of the neck and limitation of use of the upper limb. The appearance of the patient is also important. Frequently he will be found supporting his injUTed elbow with his sound hand and keeping his head inclined towards the side of the injury. The object of this position is to relax the muscles attached to the collar bone and thus alleviate the pain. Examination of the collar bone reveals the usual symptoms and signs of a fracture and there is, therefore, no need to describe them further in this article. Fracture of the Humerus The more common fractures of the humerus are those situated near the shoulder and at the elbow. When situated near the shoulder, diagnosis may be difficult since it is impossible to examine the bone satisfactorily and physical signs are few and far between. Shock, severe pain and inability to use the limb are characteristic features while tenderness is obviously present. Similar remarks apply in fractures near the elbow but here there is often obvious deformity which makes the fracture easy to diagnose. Fractures of the shaft of the humerus are usually accompanied by all the characteristics of a fracture and hence need not be further described.

Fractures of the Radius and Ulna These are most commonly broken at the wrist. A fracture of the lower end of the radius occurs as a result of a fall on the hand or through cranking up a car which backfires. They are then called a Colles' fracture or chauffeur's fracture respectively. It is not usually difficult to diagnose this inj ury since generally there is obvious deformity which makes further investigation unnecessary. In any case, tenderness is a sufficient guide apart from limitation of use and swelling. Fractures of the Hand Any bone of the hand may be broken and diagnosis may be difficult. Sometimes when one of the carpals of the hand, particularly the scaphoid is broken, the injury may not show up in the first place in an X-Ray. A later X-Ray, however, may disclose a fracture. Tenderness over any bone in the hand must in itself be regarded as suspicious of a fracture. The diagnosis is still more certain if there is swelling or defolmity. A characteristic feature of a fracture of a metacarpal bone is sinking in of one of the heads of the metacarpals. This will be pa:.-ticularly noticed if the patient attempts to clench his fist.

PLACE OF FIRST-AIDER IN INDUSTRY (cont. /rom page 1) necessary, arrangements for drying such clothing. Special welfare regulations may amplify the provisions of previous sections and, in addition, include facilities for preparing, heating or taking meals, establishing a canteen, supplying protective clothing, the supply and use of seats in workrooms, the extension of first aid and ambulance arrangements, and the medical supervision of all persons employed. Part IV has to do with the special hazards of particular industries, Part V with accidents and industrial diseases, and Part VI with conditions of employment of women and young persons under the age of eighteen. The remaining three parts have to do with special applications where factory premises are shared by different persons as separate factories, extension of premises, works of engineering construction, the employment of out-workers, and with administration of the Act. Two other Acts concern the first-aider in industry, but their provisions wiU be dealt with later. They are the Disabled Persons (Employment) Act (1944) and the Industrial Injuries Act (1946). (To be continued)

EDITORIAL ACCIDENTS IN THE HOME

WE are glad to see that the

News Chronicle has been focussing attention on the serious question of accidents in the home in a series of informative articles which we hope will have the effect of making more people conscious of this problem. For it is a fact that few people realize that more children under 15 years of age die from accidents in their homes than are killed on the roads, and that the annual toll of persons dying as the result of an accident in the home is (for 1952) 5,226. Add to this the thousands of people injured and perhaps maimed for life by accidents, and the cost in terms of hospital treatment, estimated at between £4,000,000 and £5,000,000 in 1952, and one can appreciate how necessary it is to take steps to prevent these tragedies. The situation is not being ignored. A Government inter-departmental committee has been studying the problem, and in London a ' L.C.C. public health departmental working party, with assistance from the Ministry of Health, and the R.Soc.P.A. has also made recommendations on the matter. Both these committees believe that the education of the individual in the home is the best way of preventing accidents, and that the means of tackling the problem is through the existing organization covering health education. To this end health visitors, district nurses, sanitary inspectors, and others in close contact with homes, are helping to educate people, and in many districts local home safety committees, in which in most cases the medical officer of health is a member, are being formed. When this matter was first brought to public notice, two or three years ago, we suggested that some simple first aid instructions to householders, especially as regards the first aid treatment of scalds and burns in children, would be valuable. Some sort of card which would also give the telephone numbers of the ambulance service, etc. , might well be circulated by the local home safety conumttees, and would be a useful supplement to the visits paid by the staff of the health department.

FIRST AID & NURSING, JAN ..'FEB. 1.954

FIRST AID & NURSING, JAN./FEB. 1954

Notes on advanced physiology By F. C. Reeve F.Z.S., F.R.E.S.

Introduction JUDGING from the questions which are continually being fired at lecturers to-day I am fully convinced that there is a growing demand for a more complete knowledge of physiology than can be acquired from the outline of the subject to be found in the official text-books, more than which is impossible on account of limitation of space. Especially is this the case now that so many of our nurses are seeing the hospital backstage and coming into personal contact with trained nurses. With a view, therefore, to meeting the requirements of these students I propose to present some more advanced physiology, touching upon regional anatomy as circumstances demand, and discussing the various organs and systems in greater detail and, in many cases, from a new angle. At the same time I realize that I shall have to cater for two distinct classes of student. In the first place there will be those who, whilst anxious to know more of the mechanism of the human body, have no desire to memorize a long list of Latin names. On the other hand some, more ambitious, will be anxious to learn these in order to enable them to understand better the conversations of the trained nurses and doctors with whom they find themselves working. I propose, therefore, to write many of the technical terms in brackets, and it will then be for the readers to decide for themselves whether or not to memorize them. By this means I hope to cater for both classes of student. By assuming that all my readers have already made themselves fully conversant with the anatomy and physiology of the human body as outlined so comprehensively in the official text-books, and making that my starting point, I hope to save much valuable space by avoiding unnecessary repetition. In commencing the study of physiology there is a tendency for

the beginner to regard the various organs and systems of the body as watertight compartments, each a complete and independent entity in itself, instead of realizing that they are all inter-related, their various functions being co-ordinated to form a complex whole. Perhaps this attitude has been to some extent contributed to by the treatment of some writers who, in describing each organ or system, have failed to explain these correlations as they proceed. I shall endeavour to clarify this obscure point by referring from time to time to the relationship of each organ or system to its fellows. From this it is to be inferred, rightfully, that all organs and systems are of equal importance, and that none is less necessary to the well-being of the whole than another. There is, however, one system which appears to present to most students greater difficulty than most of the others, and I will, therefore, make this the subject of my first article. The Heart and Circulation . At the bottom of Castle Hill Avenue, Folkestone, at the junction of that thoroughfare with the famous promenade known as 'The Leas,' there stands an imposing bronze statue, but I wonder how many of the thousands of visitors to this lovely Kentish resort ever take the trouble to stay and read the inscription thereon. Those who do so learn that it was erected in 1878 to commemorate the tercentenery of the birth of William Harvey, surgeon, who was born at F01kestone on 1st April ] 578, and who was to create a revolution in our knowledge of physiology by the publication in 1628 of his monumental work ' An Anatomical Treatise on the Movement of the Heart and Blood in Animals,' in which is set out for the first time an account of the circulation of the blood as we understand it to-day. Before, however, proceeding to discuss the subject from the point of view of our present day knowledge, it will be interesting

to glance, briefly, at the beliefs held by the surgeons and physiologists of that day. The anatomy (as distinct from the physiology) of the heart and the larger blood vessels was fairly well understood. It was known that the heart contained four chambers, that there were two kinds of blood vessels, each containing a different kind of blood, and that the blood was not static but moved about the body. It was believed, however, that this movement consisted of an ebb and flow, a backward and forward motion, although its actual function was but a subject for speculation, and many were the theories advanced to explain it. In short, it is clear that practically no advance in knowledge of the physiology of the heart had been made since the time of Plato, 2,000 years before. This great philosopher (429347 B.C.) had written' The heart is the fountain of the blood and sets it in motion' and 'The blood is forcibly carried round to all the members,' and Aristotle (384-322 B.C.) stated that the heart was the source and reservoir of the blood. These, however, were but generalized speculations, and we have no evidence to show that either of them really understood the circulation as we do to-day. The first use of the word 'pulse' as we understand it to-day was made by Praxagorus (345 A.D.), who also referred to the difference between arteries and . veins. Erasistratus (300-250 B.C.), also recognizing the two kinds of vessels, believed that one carried a 'san. guinous principle' which was prepared in the liver, and the other a , spirituous principle' which had its origin in the lungs. The works of Hippocrates, the Father of Medicine (460-377 B.C.), seem to show that he believed that the ' life fluid' flowed , in circles,' but he does not attempt to show the beginnings or ends of the circles. That the heart is the seat of heat was the belief of Galen (130-201 A.D.) who taught that the

air from the lungs helped to keep it burning. The Spanish surgeon Servetus (1509-1553 A.D.) and the Italian investigator Caesalpinus (1519-1603 A.D.) were both careful observers, but, although their knowledge of anatomy was comparatively complete, their physiology was scrappy. Perhaps we owe a great deal to the latter observer for our knowledge of the cardiac valves, a work which was continued by Fabricius (1537-1619 A.D.), who became Harvey's professor of anatomy at Padua. Before proceeding with our study of the physiology of the heart it is very necessary that every nurse should know exactly where it lies. Take a sheet of plain paper and cut out an acute-angled triangle 5 in. high and with a base of 3i in., and round off the corner~, using a halfpenny as a guide. Get a friend to act as a model for you and find a point on the chest 2 in. below the left nipple and 1 in. towards the middle line and place the apex of your paper triangle over this point, the tnangle lying on its side with the base directed towards the middle line. The lower side of the triangle should be slightly inclined upwards, the end of the base being 2 in. above a level line from the apex. Your . triangle will now roughly indicate the size, shape and position of the heart lying beneath the chest wall. The p.art of most importance, however, IS the apex, for it is over this that you will have to listen either with your ear or with a stetho~cope and every nurse should learn to use a stethoscope- for the cardiac impulse, of which I will write more later. In almost every ward there is a stethoscope hanging either in the medicine cupboard or in sister's room. Ask th~ staff nurse if she will kindly show you how to use it-but be tactful and choose your moment, for staff is a very busy person! Actually, the apex is the only part of the heart which is in contact with the chest wall, the base inclining slightly backward so as to be partly protected by the sternum. The. usual description of the h~art as ' a hollow muscular organ' 1111ght create the idea that the walls and divisions . of the heart are just thin sheets of muscle, and that the bulk o.f the interior is occupied by space like a football. This idea must be dispelled , for the walls and

divisions (septa, plural of septum) are formed by a solid piece of muscle (myocardium), and when the heart ~s seen .dissected it rather gives the 1mpreSSlOn of the four chambers having been carved out of the solid. A thin shell would be incapable of standing up to the enormous pressure it is called upon to exert. I am re~n~ed here of another point whIch IS ofte~ found to be confusing. Although thIS heart muscle is of a special structure, nevertheless the cells of which it is formed need nutriment and drainage just as muscles in other parts of the body ~o,. and for this purpose, like them, 1t 1S furnished with a network of capillaries carrying the necessary blood. This blood, therefore, must not be confused with the blood passing through the chambers of the heart. It is carried to the heart muscle by special arteries known as the coronary arteries, which arise directly from the ascending aorta. This special circulation, then, is called the coronary circulation and is so important that, if either ~f the coronary arteries were to become obstructed, cutting off the blood supply to the heart muscle, it would probably result in instantaneous death. Th~ heart is also, quite rightly, descnbed as a pump, but it is not to be inferred that the pumping ~ction is produced by squeezing, lIke the bulb of a Higginson's syringe or a scent bottle on a lady's dressing table. It is the result of a spasmodic contraction of the cardiac muscle (myocardium) itself, causing a sudden diminution in the capacities of the four chambers. All four chambers, however, do not contract at the same time. The auricles (called by some physiologists' atria,' which is the plural of' atrium ') and the ventricles are formed by two separate muscles, the auricles being separated from the ventricles by a thick layer of fibrous tissue. At one point, however, the continuity of this band of fibrous tissue is interrupted. This is at the wall (septum) which divides the right chambers from the left, and here we find a bundle of fibres forming a 'bridge' between the auricular muscle and the ventricular muscle. It is known as the bundle of His, and its significance will be seen when we consider the beating of the heart. (to be continued)

CASUALTIES UNION Weekend School for Dockworkers THE Welfare Department of the National Dock Labour Board held a weekend school recently at the delightful Beatrice Webb Hous~ on Leith Hill, one of the beauty spots m Surrey. The course was attended by dockworkers from London, Southampton, Rochester, Weymouth, Yarmouth, K ing's Lynn and Boston. The programme had been devised by Dr. R. R. Wilson, Regional Medical Officer to the Board in collaboration with Dr. J. E. Haine. of Casualties Union, the sec~:)[~d day bemg devoted to practical trammg. pr. ~. C. B. Young of Lewes gave a ~tlffil:llatm,g lecture illust~ated by realistic patlen~s. A demonstratlOn was also given c?f!1panng and contrasting different condltlons causing unconsciousness- apoplexy electric shock, concussion and fainting. ' In the afternoon Dr. Wilson and Dr. La:vrence Smith judged a competition in whlch the competitors had to deal with Mr. Brown (Cyril Wallis) suffering from a Co lies' fracture and concussion with a wound on his head, and with Mrs. Brown (Gladys Wyatt) who had sustained an injury to her spine. Mr. F. G. Thomas, Chief Welfare Officer to the. Board closed the proceedings. Recordmg his appreciation afterwards Mr. T~omas stated' I think for everybody there this was the first experience of the work of (Casualties) Union , and it has made a tremendous impression. It has certainly convinced me of the great value of cooperation with (the Union).' Dr. Wilson added that the school had been a great success. Ambulance Test for Queen's Scout Badge Three Boy Scouts who are candidates for the Queen's Scout Badge were called upon to deal with an accident situation at the West End Presbyterian Church Hall, Newcastle, on the 14th January. The cases were coal gas asphyxia, concussion and open fracture of the radius. The test was staged by Newcastle Branch of Casualties Union at the request of Scout Commissioner Harry Truman . The 'casualties' were Helen Nicholson, Joan Goodchild and Alex Watson. Diagnosis Practice for Nursing Divisions in Lancashire Study Circle 177, Parr, St. Helens, gave a demonstration of casualties and accident situations for the Newton and Parr Nursing Divisions of St. John on 19th January at Old Boston Colliery, Haydock. Fred Dillon demonstrated an epileptic fit brought on by burns in a fire hole at the colliery. Ben Groom portrayed a closed fracture of the lumbar spine after an accident in the pit yard. James Pendleton had sustained a Potts fracture and Ronnie Heaton had taken an overdose of insulin. To complete the misery Richard Gibson , attempted suicide' by cutting his throat. (continued on page 10)

FIRST AID & NURSING, JAN. /FEB. 1954

FIRST AID & NURSING, JAN./FEB. 1954

INDUSTRIAL FIRST AID-2

Coal Mining For the second article in our series dealing Ivith the organization and practice of first aid in industry we go to coal mining, wellknown for possessing some of the finest first aid facilities in the country. This article describes the National Coal Board's medical and first aid services, and we acknowledge with thanks the Board's assistance in its compilation.

Medical Staff UNDER the Chief Medical Officer at H.Q., there are nine Divisional Medical Officers each in charge of the medical and first aid services within his Division. In addition to these senior doctors there are 46 ful1-time medical officers (assisted in some places by part-time M.O's.) in charge of N.C.B. Areas, and their duties include regular visits to all col1ieries and ancillary industrial plants within the Area, carrying out medical examinations for various purposes, supervising the treatment and accident services rendered at Colliery Medical Centres and First Aid Rooms and carrying out a full range of activities. A small number

The medical treatment room at Usworth Colliery. Morphia is locked inside an underground steel container for first aid equipment.

of full-time medical officers and scientists are employed on medical research activities which are described briefly below. Nurses and First Aid Attendants At present the Board employs 192 State Registered Nurses. At two or three collieries more than one nurse is employed, but generally speaking each nurse works in a Medical Centre and is assisted by full-time and/or part-time first aid

An Area Doctor attends a casualty underground_at Thoresby Colliery. Ph%-W. Suschitzky .

attendants. There are about 600 full-time and 2,500 part-time first aid attendants employed in the industry. In two Divisions, Area First Aid Superintendents have been appointed to supervise all the first aid services provided at collieries and to organize and administer a medical stores supply system. Buildings The Coal Mines General Regulations (First Aid) 1930, made under the Coal Mines Act, 1911, req u i re that adequate arrangements be made

A colliery team (Old Mills, Somerset) practising in a mine gallery. This team won an area trophy in 1948.

at all mines to give first aid treatment to inj ured or sick workers. On the surface, at all except the smallest mines, first aid rooms with prescribed equipment must be provided, in charge of a person qualified in first aid. At the smaller mines a suitable place under shelter meets the requirements of the regulations but, in fact, the Board have provided separate first aid rooms at all collieries. At all pits employing more than about 800 men, medical centres are replacing statutory first aid rooms. First Aid Arrangements Underground Underground, the regulations require that a fixed proportion of workers must be qualified firstaiders and be available to give treatment when required. At the coal face one in every 50 men must be so qualified, and elsewhere underground the proportion is one in 30. First Aid Stations consist oflarge steel tubular containers in whIch dressings, stretchers, blankets, etc., are stored and placed at intervals along the roadways and close to every working coal face. Apart from these first aid stations every qualified first-aider underground carries a first aid box containing sealed sterile dressings and antiseptics. Ambulance Cars The regulations also require the Board to provide an ambulance car which must be available within 10

A new ambulance car designed by the colliery manager at Easington Colliery, A casualty on a stretcher IS placed in this car, which is sprung to reduce jolting and the car is attached to the man·riding train for transit to the cage and thence to th~ surface where tbe stretcher can be placed directly into an ambulance. •

FIRST AID & NURSING, JAN.{FEB. 1954

FIRST AID & NURSING. JAN./FEB. 1954

INDUSTRIAL FIRST AID (continued)

miles of every colliery. Since the advent of the National Health Service in July 1948, it has been possible for N.C.B. Divisions. to discharge this obligation by entenng into contracts with local health authorities for the latter to provide this service on repayment by the Board. This has been done in many places but about half the industry still provides its own ambulance car service. Specially designed vehicles for the transport of injured men underground are now widely used in South Wales and Durham-they are called , trambulances ' and other divisions are beginning to introduce these vehicles into their pits.

CONQUEST OF DIPHTHERIA In his preliminary report for 1953, Dr. J. A. Scott, County Medical Officer of Health for London, states that for the first time since records were kept there were no deaths from diphtheria during the year, and that only 28 cases of diphtheria occurred in the County during the whole of the year. The amazing importance of this is seen when one looks at previous records. Fifty years ago, diphtheria was almost the greatest killer of children between the ages of one and

Medical Examinations Since 1944 statutory regulations

Under special authorization given by the Home Office selected first aid men are trained by the Board's Medicai Officers to administer morphia to colleagues injured underground. Supplies of the drug are stored in locked safes placed at suitable points underground. The authorization is granted to individual mines on the recommendation of the Divisional Medical Officer who first satisfies himself that the necessary trained personnel are .available. Nearly all N.C.B. mines are now authorized.

have required the examination of all new entrants to the industry in South Wales and of all boys under eighteen years of age in other coal fields. These regulations were amended at the end of 1952 so that the age limit for statutory medical examinations is now 21. The position in South Wales remains the same. All these examinations are carried out by N.C.B., Medical Officers who, for th1s purpose, act as agents of the Ministry of Fuel and Power. New entrants undergo a chest X-Ray in South Wales and this will be extended to other divisions gradually. Other examinations are of members of the Rescue Brigades, Superannuation Examinations of nonI ndustrial Staff, and examination and advice to men returning to work at the collieries after sickness or injury.

First Aid Training

Occupational Diseases and Research

First aid training for miners is carried out in accordance with the handbooks of St. John and St. Andrew Ambulance Associations. Classes are organized by Medical Officers and Area First Aid Superintendents and financial assistance is given by the Board to all men undergoing training provided a minimum number of lectures are attended and a qualification obtained. Special training is given to fulltime and part-time first aid attendants to enable them to carry out that part of their duties which necessarily includes work which is outside the scope of orthodox first aid training. These special courses are run by the doctors and the training is very largely given by State Registered Nurses.

The main occupational diseases of coal mining are: Pneumoconiosis, Nystagmus, Beat Diseases, Dennatitis, Spirochaetal Jaundice (Weirs Disease). Research on all these diseasesand on some other medical and related subjects-is carried out mainly by the Board's staff in the case of pneumoconiosis and generally by the Medical Research Council or University medical departments in the case of the other diseases. The Board gives financial support to these extramural research activities. A1l research on medical and related subjects is controlled by the Board's Chief Medical Officer in his capacity as Director of Medical and Human Problems Research.

Morphia in Mines

five years; and even those who survived an attack were often left with some disabling complication. As later as 1937 the records show that 7 ,500 cases were notified in London alone and there were 250 deaths ; whilst in England and Wales there were over 60,000 cases with 3,000 deaths. How has the conquest of this disease come about? The first important step was the development of diphtheria antitoxin, in the first decade of this century; and the next was the country-wide campaign for the immuruzation of young children that started in the early years of the second world war. Diphtheria Antitoxin Bacteria produce two kinds of toxins. Their living activities give rise to waste products known as exotoxins, whilst the disintegration of dead organisms produce endotoxins. It is the circulation of these toxins in the blood that gives rise to the general symptoms of illness-such as raised temperature, quickened pulse rate, headache, furred tongue, loss of appetite and of energy, and a general discomfort throughout the body. Some organisms produce an exotoxin which quickly impairs important life processes, and an endotoxin that does very little harm; whilst others give rise to a comparatively mild exotoxin but an endotoxin which is much more virulent. The diphtheria bacillus belongs to the former group and its exotoxin gives rise to two very serious complications, such as heart failure and paralysis; the patient usually succumbing to the former within a few days. Of course, the body produces antitoxins, but not quickly enough for safety. However, it became possible to develop antitoxins in the blood of a horse by injecting him with increasing doses of toxin, until a dose which might have proved fatal in the first instance produced no ill-effects whatever. Blood was then drawn from his jugular vein, was allowed to clot and the serum was tested for purity and for antitoxic strength by injecting a series of guinea pigs with a certain quantity of the serum together with graduated doses of the toxin. The serum is then standardized in units and put into hermetically sealed phials. If this antitoxic serum is injected into a patient immediately diphtheria is suspected the toxin is neutralized as it is formed, and the severity of the attack is greatly diminished. This procedure saved many lives and did much to rob the disease of its terrors; but did not greatly decrease its incidence, and did not give protection for more than a few weeks. Immunization to Diphtheria The next step was to find a way of making young children produce their own antitoxin, for this would remain in the blood almost indefinitely and thus give a lasting protection. The problem was the making of a preparation that would be effective in developing an immunity after one or two injections without causing any ill-effects in the child. This can now be accomplished by the use of alum-precipitated toxoidcommonly known as A.P.T., a toxoid being (continlled on page 10)

We ,,,ttend a Bed Cross Competition COUNTY OF SUSSEX ELIMINATING CONTESTS The first week of November saw two important British Red Cross competitions held in Sussex. These were the Eliminating Competitions for the Stanley Shield, the National Trophy offered annually by the Society, and so keenly competed for by teams from all over the country. Men's Competition On 1st November the eliminating competition for the County of Sussex was held at Brighton, in the presence of a large and enthusiastic audience. The trophy to be competed for was the Norfolk Cup, and the winning team would then be eligible to compete for the coveted National Trophy, the Stanley Shield. The tests consisted of team, individual, practical and oral tests, and demanded a high standard of efficiency. The team test, an interesting one, was as follows : A window cleaner is cycling round a comer with his extending ladder over his shoulder and a bucket hung on the end of it. There has been rain and the road is covered with fallen leaves. He skids and mounts the pavement, thereby knocking down an old women. The team is assembled at the Red Cross Hut for a team test practice and are just about to begin an exercise when they hear the loud clatter of a pail falling outside. They look out of the window and see the accident. Injuries to be treated : Fractured lower end of First Casualty : the shaft of the right (man) humerus; Cut just above the right ankle, venous haemorrhage ; Moderate shock. Second Casualty: Fracture of the neck of (woman) left femur Severe shock. Time allowed 20 minutes. The judges were Drs. G. Danes and Rigden (Team), Drs. Parker and Digby Roberts (Individual practical), Drs. 1. Crawford and Roberts (Individual oral), Assistant County Director for Surrey, E. Hugh Hudson (Uniform). Great credit is due, also, to the 'patients' for the excellent acting and general co-operation following their training. They had come from the East Grinstead Casualty Pool, and caused considerable diversion, the' old woman' by her unearthly screams whenever she thought she was going to be touched, and the window cleaner by his anxiety to get away' as he had to clean Mrs. Brown's windows at 4 o'clock! What had they done with his bike and ladder ? This appeared to concern him much more than his injuries. Upon the return of the judges from marking their sheets, the chair was taken by Miss K. Ward, S.R.N., M.C.S.P., County Director, who then announced the result of the Competition, together with the marks obtained by each team.

Results : Total 1. Brighton. . . 801 2. Eastbourne 766t 3. Arundel ... 719 4. Bexhill ... ... ... 684 Miss Ward then asked Dr. Danes to present the Trophy to Brighton, the winning team, which he stated that he would be pleased to do. He and his fellow judges offered the competitors some very valuable ad vice in the course of their most candid criticism. Never forget the' blanket under' avoid fussiness and always attend to and transport the most seriously injured patient first. The winning team, whicb had been trained by Dr. Michaelis, was led by Civil Defence Officer G . Slade. The · County Director then thanked all those wbo had contributed to the success of the Competition- the judges who had given their valuable time and taken so much interest, Miss Stokes, the County Secretary and her assistants, upon whose shoulders had fallen the arduous task of organization. She was, also, most grateful to Commandant Mrs. M. Harvey who, at very short notice, had undertaken to superintend tbe arrangements for refreshments. Women's Competition Within a week \If the above Competition for men the Sussex eliminating competition for women was held in Hove on 7th November, before a large and appreciative gathering, and, although uniforms predominated in the audience, there were quite a large number of spectators in plain clothes, testifying to the interest taken in these competitions by the general public. Unlike the men's competition, this was in two parts, first aid and nursing. The double test, therefore, was as follows :A man and his wife are at home in their bed-sitting room. The husband falls and sustains an injury to his chin. His wife rushed in to the Red Cross Hut, where she knows that the Red Cross Women's Team is holding a practice, telling them that her husband had had a 'sudden attack,' and they return with her. In her agitation the wife trips over the flex of an electric fire. Conditions to be Treated: Husband: Epileptic fit; Severe cut on chin and bitten tongue; Post epileptic state. Wife: Colles's fl acture, simple (left) ; Burn ofright forearm; Moderate shock. Five minutes will indicate the passing of 12 hours. The team will re-enter the room at 9 a.m., finding the patients still in bed; their daughter has given them an early cup of tea before leaving for work. Five teams from all over Sussex competed in the Individual tests, and it was gratifying to note the small number of marks which separated them. The businesslike manner in which each team set about the work was a tribute to the training they had received under the British Red Cross. As soon as the judges had had an opportunity of checking their marking sheets, Miss K. Ward, the County Director, mounted the platform to preside at the (continued overleaf)

COMMENT Men's Teams In some cases taking T.P.R. appeared to be no more than a gesture. No watch was used and no record made. Sometimes it was left until halfway through the test Its valt.;e does no.t appear to be always fully apprecIated. ThIs comment applied equally to some women competi tors. It was noted that some teams became flurried near the end, obviOUSly anxious as to whether or not they would be able to finish within the scheduled time. One cannot help wondering if sufficient time is ~lways allowed. I wonder if a pilot test IS worked through before fixing tbe time allowed for the test ? Name and address of the patient was usually taken but not always written down at the time. One team, adopting the 'knee lift' for loading stretcher, failed to support the patient's head, which was hanging in an appalling manner. Why was the Old Lady lifted twice by one team ? Surely one lift was unnecessary. In one case I noted a pillow thrown into ~he middle of the road and left there, and ill another a cup and saucer were left behind. Who was responsible for offering a drink to one patient from a cup which had been used by the other without making any attempt to wash it ? Was it necessary to waste time in removing the bicycle and ladder (apparently) over to the other side of the road when it could have been stood against the wall on tbe same . side? These were no longer' causes' except as objects which might be tripped over. ~romen's Teams

I would like to have heard a cheery , Good-morning' upon arrival next day. Apart from this, 'bedside manner' was good. One interesting question arises in connection witb this test. Should tbere have been a 'next morning'? The husband was suffering from an ordinary epileptic fit which, in the absence of contra-indication, should have passed off in a few minutes. The text-book mentions no possible aftereffects, nor does it explain 'post epileptic treatment.' Even if the members thoroughly understood the aetiology of epilepsy and the technical nursing of this malady no marks would have been given for any treatment outside that described in the text-book. H is other inju rjes (again no con tra-indica tion) were comparatively trivial. In the case of the wife, .as soon as the burn bad been adequately protected from possible infection and the moderate shock dealt with, immediate hospitalization was indicated in order that reduction could be effected as early as possible. Knowing, therefore, that the patient would be anaesthetised within, possibly, a few minutes, nothing should bave been given p .o. The burn, also, would have been treated in casualty. The teams would know from experience that it was to be both a first aid and nursing be expecting to test, and would see a bed or beds. The presence of the beds, therefore, would exercise an influence upon the subconscious mind, and they w<?uld, in consequence, naturally get the patIents into bed, in readiness for the nursmg test (continued ol'erleaf)

FIRST AID & NURSING,

COMMENT

SUSSEX COMPETITIONS (cont. ) Presentation Ceremony. Miss Ward then introduced Lord and Lady Woolton, whose interest in the ambulance movement was well-known to all , and she was supported on the platform by the Mayor and Mayoress of Hove (Councillor and Mrs. A. E. Brocke), the County officers and the judges. The judges were .: Drs. Danes and Richards (team, first aid) , Mrs. W . .E. Gardiner, S.R.N. (team, nursing), Dr. Brms Young (First Aid, pra.ctical . and C?ral , officers), Dr. E. J. Goff (FlfSt Ald, practical, members), Dr. Rex-Binning (First Aid , oral, members), Mrs. P. M. Piper, S . R.~. (Nursing, practical an~ oral, offi.c ers), MIss Harris, S.R.N. (Nursmg, practlcal, m~m bers), Mrs. 1. M . Pryor, S.R.N. (N~rslOg, oral, members), and Mrs. H. ~. Robmson, County Secretary for Kent (Uniforms) .. The judges then addressed th~ gat~~n.ng, offering both valuable a nd candld cntlclsm and useful advice, which were much appreciated, both by the members of the competing teams and by aU those engaged in first aid and nursing. In treating bums the sterilized dressings specially provided for this purpose must ~e used. Some teams had overlooked thiS. They also emphasized the importance of the • blanket under. ' However well the patient may be covered on top there were always cold draughts on the floor. They were, however unanimous in congratulating the teams upon the very high standard attained , but go on to do better still' they urged. The results for the Thomas Stanford Trophy for the best team were then announced, together with the marks obtained by each team, and are as follows :Total Hove ... 828~Bexhill 803Haywards Heath 735 Bognor . .. . .. 734iWinner of the Gardam Nursing Cup (team) : Bognor. Winner of the Beaumont Cup (team leader): Miss Baker, BexhiH (quarter-master). The Final for the Stanley Shield will be held at the Friends' House, Euston Road, London, on Saturday, 22nd May, 1954. As soon as the results h a d been announced Miss Ward in vited Lord Woolton to present the trophies. Lord WooIton said that it gave him much pleasure to do so, for he had long been interested in this great work. He recalled that on one occasion he had met with an accident and was being carried by some untrained passers-by, one of whom accidentally let go, with the result that he received a nasty bump. Some time afterwards it was necessary for him to be transported, but this time it was by a Sussex team of the British Red Cross, and he could not have wished for gentler handling. He hoped that if it were his misfortune to experience another accident it would be in Sussex! He then went on to praise the voluntary spirit which inspired so many men and women to give time and labour to training to help their fellow creatures. Lord and Lady Wool ton were thanked by Miss Ward on behalf of all for the very great interest they had always shown in ambulance and nursing work, and especially for having presented the trophies that day. The County Director also thanked all those who had contributed to the success of the afternoon.

(continued) which they knew must follow, against their better judgment. General In many cases palpating for fractures of the long bones is no more than a gesture. I saw one competitor pass the palm of his hand from the neck to the feet of the patient in one stroke (yes, over clothing), first on one side and then on the other, obviously perfectly satisfied that there was no bone injury. No top-ranking ort.hopaedic surgeon in the world could posslbly discover a fracture of one of the long bones in this manner Much confusion, I think, might be avoided, and better team co-ordination achieved if some members of the team were allotted certain fixed tasks should occasion arise. It could be the duty of one always to deal with ' phone and other messages, make enquiries about doctor, hospital, shelter, transport, etc., and take name and address of patient(s). He might, also, if not engaged upon a separate patient, hand out material to those actually attending to patients. It might be the fixed duty of another to stop oncoming traffic (from both directions) and keep back a crowd. Organization on these lines would prevent the confused rush on a patient by the whole gang, which we so often witness, and at the same time ensure that none of these essentials are overlooked. -F.C.R.

DIPHTHERIA (continu ed from, page 8) a judicious combination of toxin and antitoxin . A.P.T. is injcded into the arm and is absorbed by the blood so very slowly that it has a sustained effect in stimulating the production of antitoxin . A second, and larger, dose should be given four weeks later ; and three months after the injections a skin test should be done to make certain that immunity has been gained. This immunity should last for life. Most babies inherit a degree of immunity from their mothers which protects them during the first few months of life but is rapidly lost towards the end of the first year; and this is the best time fQf the child to be immunized, for the incidence and mortality of diphtheria is greatest between the ages of one and five years. The campaign for immunization that has been going on since 1940 has resulted in over half of the children in this country being immunized before reaching the school age of five years, and many of the remainder during their first term at school. This immunizing treatment is now an integral part of the preventive work of every health department throughc 1t the country. Not only is the individual child protected, but it is believed that if all children were immunized a completely protected population would grow up, and diphtheria would become, in the future, a condition of purely academic interest. 1

'The Faber Medical Dictionary.' Edited by Sir Cecil Wakeley. Faber & Faber, 45/-. One of the best medical dictionaries which has come our way. Mainly compiled for the use of doctors and nurses, neverthe-

JAN. /FEB. 1954

FIRST AID & NURSING, JAN. /FEB. 1954

LETTERS

The Artny looks to you to look after the Army!

DEAR SIR, In answer to J.T.R., Coventry (Readers' letters, Nov. /Dec. issue), and all others interested in raising the standard of ambulance work, I would bring to their notice The Institute of Certified Ambulance Personnel, whose objects are, through examination, to serve this very purpose. I therefore strongly advise J.T.R., and anyone desiring this end to form a study group with its object the taking of this Institute's examinations and qualify for an efficiency in ambulance work second to none. Further details of the Institute's examinations may be obtained from 'the General Secretary, 5 Grove Terrace, London, N.W.5. I am, Sir, Yours truly, DEREK A. HOWARTH,

Where the Army goes .. . go the girls of Queen Alexand ra's Royal Army Nursing Corps. They see foreign lands. They do a variety of jobsinteresting, important jobs. Companionship lights the way. Behind them is a proud tradition. In front-the chance to go onwards and upwards, to reach SRN standard, to hold a commission. How about you? If you are between 17 1 a nd 35, here's your chance to train for an absorbing life. You need no special experience. Keenness and good health will take you far. Your training will b e free. You will be well paid. You will have 30 days' lea ve a year. After 9 months YOLI can apply to become a specialist.

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DEAR SIR, I read with interest in the November/ December issue of First Aid & NlIrsing about a reader who signed himself J.T.R. , of Coventry , who asked Dr. A. D . Belilios about forming a First Aid League. r was the Founder and Secretary of the Rotherham and District Works First Aid League in 1943 which ran for several years until the collieries withdrew and formed their own league under nationalization. A League was formed in Sheffield in 1949 under my guidance, but without me taking any official part, this is still going strong. If I can be of any use to J.T.R., Coventry, he can have any information he wants. As a matter of interest T have been a competitor, judge, and · captain, in these leagues and my position is that of First Aid Superintendent at a large works, and also hold the rank of Divisional Officer and Press Relations Officer in the Rotherham St. John Ambulance Brigade. Yours faithfully, CYRIL T. GREGORY. ROTHER HAM. Casualties Union (continued from page 5) The nurses were divided into groups of four to deal in turn with the situations. They were able to practise diagnosis and treatm ent in each case and were so pleased with the interesting evening that they have requested further meetings of the same kind. Atomic Establishment Civil Defence Members of the Newbury Study Circle (No. 174) have visited the Atomic Weapons Research Station to provide exercises for the Civil Defenders. This enthusiastic Study Circle, under the leadership of George Wakelin, has just succeeded in gaining 12 promotions to full membership of the Union . less it will be of value to all who need to know the meanings of medical and surgical terms. The eminent editor is President of the Royal College of Surgeons, and he has haa the collaboration of many well-known experts, in compiling this work.

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A few of the Subjects treated:

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First Aid What to Do in Emergencies Influenza, Colds, etc. Measles, Mumps, Catarrh Corns and Warts Physical Culture, Self Defence Treatment for all Skin Diseases The Lungs, Pleurisy Hygiene. Anatomy, Pharmacy Fevers, Bladder, Kidneys Pregnancy, Childbirth Home Remedies, Diet

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FIRST AID & NURSING, JAN./FEB. 1954

Beaders~

queries

* First-Aider~s Crossword No. 9

FrRST AID & NURSING, JAN.;FEB. 1954 13

FOR

EVERY

LOCAL GOVERNMENT NEED

Compiled by W. A. Potter

Answered by Dr. A. D. Belilios J. W. F. (Manchester) writes :As a general rule, we are taught in cases of unconsciousness to lower the head and shoulders when the face is pale. But in concussion, the reverse is recommended. Can you kindly give us an explanation for the apparent contradiction?

Answer I think the explanation is to be found on page 165 (S.l.A.A . manual) which suggests the possibility of compression of the brain supervening. This may be difficult for a first-aider to recognize in its early stages particularly if shock is present initially. By keeping the head and shoulders raised, the first-aider is playing for safety as he should always do.

R. F. F. (Epping) writes :When fractured ribs injure the lung and there is coughing, the spitting of blood, shortness of breath, etc., we are warned not to apply anything tight round the chest, presumably for fear of causing further injury. Is there not some risk that complications may be caused by tight bandaging round the chest even in the uncomplicated cases ? Answer No, the risk is minute. The support afforded by a first-aider applying broad bandages firmly round the chest is unlikely to injure the lungs. Indeed, to let you into a secret, some surgeons, even apply a similar method, strapping instead of broad bandages, in the complicated cases because they do not feel that the support afforded can do further harm. It requires considerable force-generally direct violence -to injure the lungs. You must not do it, however.

K. E. (Aldershot) writes :The S.1.A.B. textbook attaches great importance to cleanliness of the hands when dealing with wounds and on page 94 states ' (2) that if scrubbing or washing is not possible the (continued on page 14)

ACROSS 1. Now describes the physiotherapist? (4,4,3,4) 9. Another physiotherapist rues (7) Sam coming back . . . 10. Room for beginners .,. (7) 11. Artery, crest, or fossa... (5) 12. Discharged by bowels, kidneys, (7) lungs, and skin 13. Ubiquitous anaesthetic (5) 16. Measure (Yankee way) plum ... (4) 17. True skin (6) 19. Bury between ... (5) 20. They are not medically qualified (6) 22. Will be of use here (4) 24. Arranged for cadets in summer (5) 27. Scrub a girl for infectious (7) disease. Is it foreign ? 29. Hiding place for food... (5) 30. Blemish from top-skin (7) 31. Nuts and tea mixed give serious (7) wound infection 32. Accidents and these are the tirst-aider's concern (6-9)

DOWN (7) 1. May be a sign of injury to leg 2. Had sly gin in violent hasty (9) manner (6) 3. How? 4. A bird in the mouth? Unfor(6) tunate condition! 5. Is this the painful part of the (6) train ? 6. Don't minimize this symptom, (3-4) especially in children 7. Perceptive organ many a youth (2,3) has for the girls 8. Times when we are rewarded (3-4) for our labours (4) 14. Of slender physique (5) 15. Over and above the usual (4) 17. Transfusion (in hospital) (9) 18. Drugs to cure disease (7) 20. Important in road transport (7) 21. Eels lip will make this shape ... (7) 23. The ideal for all dressings 24. Parts of the face found in (6) gigantic ant hills (6) 25. Of the mind or the chin 26. He acts in variety and injury (6) results (5) 28. Cooked in an oven

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SOLUTION TO CROSSWORD No. 8 ACROSS 1, Neat job; 5, scurf; 9, electrode; 10, nerve; 11, lark; 12, tibia; 13, stye; 16, secrete; 17, element· 18 forceps; 20, enteric; 22, mess; '23, ~ note; 24, tear; 27, rumen; 28, on account; 29, sonne; 30, trained.

DOWN 1, Needles; 2, a merry christmas; 3, jute; 4, bromide; 5, sterile; 6, ulna; 7, first degree burn; 8, present; 14, fever; ]5, teeth; 18, femoral; 19, syncope; 20, extract; 21, carotid; 25, anon; 26, octa .

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FIRST AID & NURSING, JAN./FEB. 1954

READERS' QUERIES hands ma), be made sterile by using an antiseptic.' This statement has been queried by our Divisional Surgeon and y our opinion would be much appreciated. Answer The text book quite rightly emphasizes the importance of clean hands, etc. , when deaLing with wounds. There is no worse advertisement for the first aid movement than to see a first-aider dealing with a wound without adequately cleansing his hands- quite apart from the dangers to the patient. Otherwise I am inclined to agree with your Divisional Surgeon as I think it is very difficult- if not impossible- to get the hands completely sterile. Nevertheless the measures recommended reduce the risks to a minimum.

B. B. (Bournemouth) writes :There seems to be a difference of opinion as to the use of knee pillows. They are recommended in the S.l.A.A.

Home Nursing Manual and the B.R.C.S. Nursing Manual, but some of our members who have visited hospitals and nursing homes find that they are now forbidden. Your views on the subject wil! be much valued. Answer There is no doubt that knee pillows have become unpopular in recent years. The reason for this is that it is now thought that they are liable to increase the risk of phlebitis, i.e. , the clotting of blood within a vein which is an unpleasant complication. The modern tendency is to keep a patient slightly on the move in bed in most diseases rather than to adopt absolute rest as formerly. * * * J. J. P. (Blackpool) writes :M y training in .first aid has always led me to believe that the chief danger of dogs to human beings is lockjaw if they bite and the wound is not properly attended to. I have now heard that a serious disease can be conveyed to the human being through dogs and shall be grateful for any information you can give me. Answer A disease called Canicula Fever

FIRST AID & NURSING, JAN,fFEB. 1954

has recently been described in the human. It is transmitted from a sick dog, contracted by those who look after it. It is an acute infectious illness producing symptoms very similar to those of meningitis of which it is a variety. Injections of penicillin have cured the complaint.

GARROULD'S for the

Regulation Uniform for

OFFICERS

Institute of Certified Ambulance Personnel The following were successful in the Examinations of the lnstitute held in Manchester on 17th October, 1953.

MEMBERS

OF THE

ST. JOHN AMBULANCE BRIGADE

Final Examination Miss A. Birch, Manchester ; Miss E. Dodd, Huddersfield ; W . Fisher, Oldham; D. F. Foster, Birkenhead ; D . G. Hanson , Halifax; L. Hanson, Halifax; J. H. Heath, Chester; J. E. Hesketh, Southport ; J. Hurst, Manchester ; A. W. Lloyd, LiverpooL; J. D. Medcalf, Lytham St. Annes; Mrs. C. Shackleton, Nelson; C. B. Shawcroft, Southport ; Miss E. Wood, Manchester; G . H. Wright, Derby. (The first place was gained by Miss Amy Birch). Preliminary Examination R. Barnes, Chorley ; J. Delaney, Farnworth; J. W . Gjlbody, Farnworth ; Mrs. 1. M. Hulland, Birmingham ; R. G. Minchin, Preston ; J . S. Wilkinson, Wigan . (The first place was gained by Mrs. Ida Hulland).

& (Female only)

Established over 100 years ==================3 We have specialised in the making of Nurses' U nW a reputation for good quality materiaJ.s : : ssuper for bnearly 100 y~ars and have workmanship You can order your St. John Ambulance Uniform with confidence kn . ' detail will be in accordance with regulations.' owmg that every We shall be pleased to send full deta£ls upon request.

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SMAE FIRST AID Competition Papers, Series N o. 3/ 12 .5 t~a.m tes ts and 2 individual test a er 51-d ' n~RlndlVldual test papers. 51-d . Selby IlJo:right ' ussel! Street, KetteClng. Phone 3727. .

INSTITUTE

(Dept. FA) LEATHERHEAD, SURREY

FTRST A[D & NURSING, JAN./FEB. 1954

Aid for the Brigade

Be on the safe side!

L TO. BARNETT MITCHELL Tel: CLErkenwell 9274 (5 lines)

MITCHELL HOUSE, 228 OLD STREET, LONDON, E.C.2

can save much pain and many man hours. We hold stocks of

Lint, Cotton Wool, and all

Officers :in Black Woaded Worsted JACKET .................................... from £7 9 9 Ditto £2 16 0 TROUSERS............ ............ ......... " in Quality Sheen Grey Melton £11 5 7 OVERCOAT ................... ············· " in Black Wool Gaberdine RAINCOAT ........................ ···· .... · " £12 11 8 CAPS... .. , .. , .. , ....................... , .. , .. .according to rank Privates : TUNIC (Lay down Collar) ............ from £3 18 3 in Black Tartan, New Pattern (Lined sleeves 5/6d. extra)

£2 6 0 £5 18 5 11 9

Efficient FI RST AID

Surgical Bandages, Dressings,

1954 PRICE LIST

TROUSERS.......... ............ ..........." OVERCOAT ................................ " CAPS ............... " ............ ......... .. .

FmST AID & NURSING, JAN./FEB. 1964

Ditto in Superfine Grey Cloth Regulation

PRICES INCLUSIVE OF PURCHASE TAX

Uniform Contractors to H.M. 6overnme"t and Public Bodies~ etc.

first aid requisites. SEPTONAL. cleanses and heals wounds with amazing rapid ty . Prevents and arrests inflam. matlon A safeguard against blood - pOisonin Possesses extraordinary styptic properties. g In liquid form SEPTONAL Is supplied in 16 oz. bottles at 3/3. quart 6/6, ~ gallon 10/. and I gallon bottles at 18/- per bottle and in concentrated form in 2 oz . bottl~s for making up I gallon at 15/· per bottle. ' SEPTONAL ANTISEPTIC OINTMENT This .ointment is most useful for boils minor ~nJu"es and skin troubles Available in ! Ib Jars at 2/9. ~ lb. 5/. and I lb. 9/- per jar. . Be on the .. safe" slde-5eptonal

S~.,i;iial ANTISEPTIC &OINTMENT The I. D. L. Industrials Ltd .. ,

THE HOUSE

FOR

HUMAN "SKELETONS Articulated and Disarticulated HALF SKELETONS, Etc., Etc.

ADAM, ROUILL Y & "CO.

Human Osteology, Anatomy, Etc. 18 FITZROY STREET, FITZROY SQUARE, LONDON, W.1 TELEPHONE; MUSEUM 2703

I, St. NIcholas Buildings, Newcastle-on-Tyne, I.

THE INSTlTUTE OF CERTIFIED AMBULANCE PERSONNEL

Nineteenth Edition. Completely revised. 261st thousand 286 pp., 286 illustrations, some coloured, 65. 6d., post 4d. WARWICK AND TUNSTALL'S

FIRST

TO THE INJURED AND SICK

lVIEMBERSHIP OF TIDS INSTITUTE IS NOW OPEN TO ALL THOSE HOLDING FIRST AID CERTIFICATES.

Enquiries are invited from all those who wish to see an increase in the standards of efficiency and training of ambulance and allied first aid workers, and who wish to increase their own qualifications by taking the Institute's Examinations.

Edited by A. P. GORHAM, M.B., Ch.B., M.R.C .S. Police Surgeon, City and County of Bristol

'FIRST AID' WALL DIAGRAMS 26 X 40 in. A- G Anatomy and physiology. H - J The triangular bandage. K, L The roller bandage. M, N Haemorrhage and woun J s. 0, P Dislocations and fractures . Q, R Transport. S Artificial respiration. ~gJe

The next Examinations will take place on April 24th, 1954. The Preliminary Examination will be held in Burnley, Lanes., and in London. The Final Examination will be held in London. Details of member5hip of the Institute, and application forms for the examinations can be obtainedfrom The General Secretary, . 5 Grove Terrace, I.Jondon, N.W.5.

AID

Sheets:

Linen - 6s. 6d., po~t 4d.

Pap .. r - 35. 6d., post 4d. Set of 19, on Roller:

Linen - 1265., post free . 635., post Is. 2d.

Paper -

The Brlthh Red Cross Society have specially adopted a set of 6 sheets , A, D. M. N, 0, p. which can be supplied on linen with fittings for the special price of 40, . post 8d.

BAI ttl ERE BOOKS FOR FI RST AI DERS A HANDBOOK OF

ELEMENTARY

ELEMENTARY NURSING

ANATOMY & PHYSIOLOGY Arthur D. Belilios, M.B., B.S., D.P.H., D. K. Mulvany, M.B., F.R.C.S., and

Arthur D. Belilios, M.B., B.S. , D.P.H., and Dorothl'a Duncan-Johnstone, S.R.N. This handbook is the ideal guide for anyone who is called upon to carry out any ~orm . of . emergency nursing. It de~cr~bes m SImple language the basic prlDClples and procedures that underlie the science of nursing, and contains brief descriptions of the more common diseases, with general notes on the nursing required in each case. A complete chapter is devoted to the subject of home nursing, and the whole book provIdes for every first aider the essentials of nursing in a handy yet comprehensive form. With 314 pages and 57 drawings, 7s. 6d.

Katharine F. Armstrong, S.R.N., S.C.M. A handy, compact manual which gives a cOI?plete outl ine of the anatomy and physJOlogy of the human body. It is simply written and f ully illustrated.

"This straightforward and reliable little book is to be walmly recommended for all w.ho maybe ~ontemplatingtakingup nursmg of any kind."-The NlIrsing Times.

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................ copy/ies of A Handbook of Eiementary Nursing . ................ cOPY/les of Elementary Anatomy and Physiology

for which I enclose remittance of ....................... (Postage 6d. extl'a per volume.) Name ........ ..... ............... ........................................ .... ............................................ ..................... . Address ............ ........................ ···· .......... ·.. ··· .... ··· .. ·................................................................. .

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A MOBILE DISPENSARY AND CLINIC

FIRST AID Be NURSING

No. 699, Vol LIX

MARCH/APRIL 1954

PRICE FIVEPENCE 3/3 per Annam Pose Fr••

Built for Service in Jamaica

HIS is a dispensary and first aid clinic, capable of being used for the performance of minor operations, and for the treatment of diseases.

SKIN INFECTIONS are primarily caused by Staphylococci, Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms.

One of its two compartments is fitted for the dispensing of medicines, etc., complete with stills, hot and cold water, refrigerator, and all the necessary compartments for the storage of drugs. The other section is equipped as a surgery, again with hot and cold water, and cupboards specially made for the storage of surgical instruments, microscopes, etc.

ANTIPEOL CUTANEOUS OINTMENT is a preparation which incorporates the sterile broth filtrates of the three infective microbes in an ointment base of proved efficiency further to accelerate the process of rapid healing.

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YOU ARE INVITED TO APPLY FOR FULL DETAILS Of MOBILE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD '

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47 High Path, London, S. W.19

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ANTIPEOL OINTMENT is both non-adhesive and

bactericidal thus obviating the need, when not convenient, of changing the dressings every day. FOR CUTS, ABRASIONS, BOILS and numerous skin infections, A TIPEOL is unquestionably the remedy. It is already in widespread use by the medical and nursing professions in many parts of the world. ANTIPEOL is therefore an essential component of every First Aid and Nursing Kit.

antipeol cutaneous ointment Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTIPEOL for ocular infections; DETENSYL for reducing arterial tension.

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Printed by HOWARD, JONES, ROBERTS & LEETE, Ltd., 26-28 Bury Street, St. Mary Axe, London, E.C.3, and published by the Proprietors, DALE, REYNOLDS & Co, Ltd., at 32 Finsbury Square, 'London, E .C.2, to whom a·ll communications should

be addressed.

FIRST AID & NURSING, MARCH/APRIL 1954

UNIFORMS and LADIES~ GREAT ~OATS & ~OSTUMES for Divisions of the St. John Ambulance Brigade can be obtained from

MEN~S

DOBSON & SONS (London) UNIFORM CLOTHING AND EQUIPMENT MANUF ACTURERS S.E.1 LONDON BRIDGE 154 -164 TOOLEY STREET 'Phone:

'Grams:

Hop 2476 (4 lines)

"Hobson, Sedist, London"

PATENT

"PORTLAND"

First Aid

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

.Nursing Marchi April 1954

In this Issue Place of the first-aider in industry

Fractures and sprains

Industrial first aid-3

Notes on advanced physiology

Competitions

Casualties Union

Nursing notes

Readers' queries

First-aider's crossword ...

no you know

that • ••

A. Shows the two stretchers in position. B. Shows the top stretcher lowered ready for loading.

Children possess a larger body surface in relation to their weight than adults ?

C. Illustrates the same Gear with the top stretcher frame hi.nged down for use when only one stretcher case is carried. D. Shows the same position as in " C • only with cushions and back rest fitted for convalesc.ent cases.

Poultices should be renewed frequently in order that the transfer of heat to the body may be continuous ?

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

The contents of a pump-type fire extinguisher (which contains carbon tetrachloride) is an excellent insecticide ?

Full catalogue of Ambu lance Equipment No.7 A will be sent on request.

65, WIGMORE STREET, LONDON, W.I 'Phone: WELbeck 0071 (Late GREAT PORTLAND STREET)

By Agnes Pavey S.R.N., Diploma in Nursing (Lond. Univ.) First Aid Boxes or Cupboards UNI?E~ Section 45 of the Factories Act It IS compulsory that first aid boxes or cupboard shall be supplied in every industry employing ten or more persons. These boxes or cupboards are of three standard types : -

AMBULANCE GEAR The Gear iIIustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

The Place of the N nrse and FirstAider in Indnstry-2

Gargles, douches, etc., are more effective if given warm?

Chocolate stains can be removed by applying borax, washing in cold water and afterwards soaking in boiling water ? Immunity to typhoid can be procured by injecting dead typhoid bacteria ?

Standard A.-These are the smallest of the three types. They are intended for use in factories and workshops using mechanical power where the number of employees does not exceed ten, or for factories not using mechanical power where the number of empl~yees does not exceed fifty. They must contam a copy of the first aid leaflet (Form 923) issued by the Ministry of Labour and National Service, a specified number of sterilized dressings in three sizesfor fingers, for hands and feet, or for other injured parts of the body; small and large sterilized burn dressings; a bottle of 2 p.c. alcoholic solution of iodine or a 1 p.c. aqueous solution of gentian violet; and a bottle of sal volatile having the dose and mode of administration stated on the label. St~ndard B.-These boxes or cupboards are mtended for use in factories using mechanical power in which the number of employees exceeds ten but does not exceed fifty. They have the same basic contents as Standard A boxes, but a larger number of each type of dressing and, in addition, a supply of sterilized cotton wool in halfounce packets and some eye-drops prepared as described in the first aid leaflet (Form 923).

Standard C.-These boxes or cupboards are intended for factories employing more than fifty persons. They have twice as many of each type of sterilized dressings as in Standard B and, in addition to the other contents, they have a supply of suitable splints and cotton wool or other material for padding, a supply of adhesive plaster, a tourniquet, a dozen roller bandages, half a dozen triangular bandages and some safety pins; but these additional articles need not be included if the factory has a properly equipped ambulance room. In any case, only one of the first aid boxes need contain these items ; but it must be placed and maintained in accordance with the provisions of Section 45 of the Factories Act. It is, however, illegal to keep articles other than those required for first aid in these boxes. Quality of Dressings All dressings supplied in first aid equipment must be made of materials of a grade or quality not lower than the standards prescribed by the British Pharmaceutical Codex. They must be sterilized, and each dressing must be separately packed and sealed. The Chief Inspector of Factories may approve, by certificate, of the substitution of adhesive wound dressings for the small and medium size sterilized dressings. Many manufacturing chemists now supply the various types of dressings required, and even the standard boxes fully equipped according to the legal requirements. The first aid leaflet (No. 923) is

usually clipped to the inside of the lid or the cupboard ~oor. It gives suggestions for the first aId treatment of minor injuries burns and scalds, acid and alkali burns and eye ~juries; and stresses the importance of treatmg every scratch or slight wound (mmediatell, for the risk of septic infection IS greatly mcreased by delay in treatment. In c~rtain industri~ special equipment is reqUITed by vanous Regulations and Welfare Orders, in order to give first aid in accordance with the particular hazards of the industry concerned. Position of First Aid Boxes or Cupboards The number oC first aid boxes specified in the A~t is on~ for every 150 employees, any fractlOn of this number being considered as 150; but when works have many small units it is advisable to have extra boxes. The best position for each box must be carefully considered. If accidents are prone to occur more often in one part of a workroom than another, owing to the machinery or type of work, it is obviously desirable that the first aid equipment should be in that part; but the presence of steam or chemical fumes must be taken into account. Where these conditions exist there is usually a foreman's office attached to the workroom and this may be a suitable location for th~ first aid equipment. Dust or dirt should not affect the dressings as each one is separately packed and sealed and the standard boxes are practically dust proof. It is essential that all employees should know, not only where the first aid box is kept, but also who is in charge of it. It is suggested that the person responsible for giving first aid, should the necessity occur, should wear a distinctive arm1et whilst on duty. Medical, Nursing and First Aid Personnel Although compliance with the provisions of the Factories Act forms the basis upon which first aid and welfare services are organized in industry, many firms do not restrict the care of their workers to actual legal obligations but the extent of the services supplied must be influenced by the size of the finn and by the availability of services in the neighbourhood. It is, therefore, convenient to consider the health services provided by four main groups of industrial organizations. Factories or workshops large enough to employ a whole-time industrial medical officer and a fully qualified nursing staff. (2) Those employing a State Registered nurse or a specially trained whole-time first aid staff, and either a part-time medical officer or a doctor who is on call. (3) Smaller factories or workshops with more than fifty employees wherein, although no permanent medical, nursing or first aid staff are employed, a person 'trained in first aid' is in charge of first aid boxes and is responsible for the immediate care of the sick and injured. (1)

(continued on page 15)

FIRST AID & NURSING, MARCH/APRIL 1954

A COURSE IN ELEMENTARY FIRST AID

• Fractures and sprains By A. D. Belilios M.B., B.S. (Lond.), D.P.H. (Eng.)

This series of articles is being written at the request of a number of students who felt that it was desirable to have a special course on standard first aid. At the same time, whenever possible, emphasis will be given. to the more advanced aspects offirst aidfor the benefit of the more advanced reader. In this number, therefore, the ~heoretlcal aspects offractures will be continued and, without delay by an interim article, strains and sprains will be described.

Fracture of the Pelvis HIS is a severe injury and generally occurs as the result of a bad injury, for example, in crushing injuries as occur in runover accidents. As usual the general symptoms and signs are marked, particularly those of shock. The patient complains of severe pain in his hips and feels as if he is falling to pieces. The pain is worse on attempting to move the lower limbs. Often the feet are rolled outwards and lie powerless in this situation. Most of the other signs of fracture are absent but careful examination often determines an area of tenderness. In doubtful cases, the first-aider may attempt to discover the sign called conjoined pressure. This consists of gently compressing the pelvis inwards by placing the two hands on opposite sides of the hips. If on such compression the patient complains of increased pain, it is very probable that a fractured pelvis has taken place. A serious complication of a fractured pelvis is injury to the bladder, or the urethra-the little tube that conveys urine from the bladder to the outside skin. This complication is suggested if the patient passes blood; moreover, the patient will often have the desire to pass urine but will find he has difficulty. It is important to advise the patient to restrain his desire until he has been examined by a medical man, otherwise the urine may pass in the wrong direction and form a swelling in the fat of the crutch or lower part of the abdomen-a complication known as extravasation of urine.

Other organs and blood-vessels in the pelvis may be damaged, thus the rectum may be injured and blood may be passed per anum. Internal bleeding may occur if important blood-vessels have been damaged. Fractured Femur This is common particularly in elderly people when it affects the neck of the bone. It is usually caused by indirect violence. The patient complains, of course, of pain in the hip and there is considerable limitation in use of the limb. The most characteristic features are shortening of the limb due partly to impaction and partly to muscular spasm. Eversion of the foot, i.e., it being rolled on to the outer side where it lies powerless, is also a characteristic sign. Confirmation of the diagnosis is obtained by detecting tenderness which can be easily done even through the patient's clothing. Fractures of the remainder of the shaft of the bone are not usually difficult to diagnose since the characteristic features of a fracture are generally present. Fractured Patella This injury may be caused by direct violence such as a fall on the knee in which case the fracture is usually comminuted ; more usually, however, it is caused by muscular action in which case the fracture is transverse and the fragments are pulled apart. Despite it being a small bone, fracture of the patella is usually associated with complete loss of use of the lower limb. There is, of course, severe pain with tenderness and swelling. Swelling of the knee

joint soon makes its appearance and is due to excess of synovial fluid in the joint (synovitis) or blood. If the patella is examined it will be found that the upper fragment has generally been drawn well above the joint. Fractures of the Leg These are common and may affect one or both of the bones. When the tibia is broken all the usual symptoms and signs of a fracture are present and often the foot is rolled to its outer side. A common accident in the region of the ankle is called a Pott's fracture. It affects the lower end of the fibula about Ii in. above the joint and often the foot is grossly displaced. Sometimes, however, the tibia acts as a splint for the fibula and there will be no displacement. In this event, diagnosis has to be made entirely by discovering tenderness on the bony knob on the outer side of the ankle. When marked displacement is discovered there is usually also a fracture to the lower end of the tibia. A compound fracture of the tibia is one of the most common results of a road accident. Fractures of the Foot These are similar to those of the hand in that they are difficult to diagnose. One or more bones of the foot may be broken and there are the usual symptoms of severe pain accompanied by swelling and bruising. Strains and Sprains Many students have difficulty in remembering the difference between a strain and a sprain. Fortunately

however, there is an easy method of remembering. Muscles, which are liable to strain, generally consist of a fleshy portion, known as the fleshy belly, and comprise what we normally eat as meat. This fleshy belly terminates in a string-like cord known as the tendon which is joined to the bone on which the muscle exerts its pull. This anatomy applies to the majority of cases but it is only fair to emphasize that in certain muscles the fleshy belly arises more directly from the bone or is inserted in a different way. Nevertheless, it should be noted that the word tendon contains a ' t' and so does the word strain hence it should be easy for the student to remember, for the rest of his life, that a strain refers to a muscle. The term 'strain' refers to any condition where a muscle is stretched or torn whether it be of the voluntary or involuntary type. The injury usually results in the sudden wrench or jar and the muscles most commonly affected are the back, thighs, forearms and legs. Terms like 'tennis elbow' 'tennis leg,' etc., refer to a strain. A strain is usually the result of a sudden exertion which causes the muscle to move in its wrong direction or further than its normal. If the strain is sudden the patient complains of a severe pain which may be accompanied by a feeling as if something has snapped and there is loss of power of the muscle concerned. Thus, a common accident occurs when, on attempting to lift a heavy weight; the patient notices something give way in his back and there is severe pain and inability to move. Advanced first-aiders, however, must never forget that this set of symptoms may also be due to a displaced intevertebral disc-an injury which will be referred to later in these articles. These, then, are the chief symptoms of a strain. Tenderness and swelling may accompany the injury but the diagnosis is generally made on the history. Moreover, if a considerable tear of the muscle has occurred, bruising is a characteristic feature. This bruising, however, may not make its appearance for several days since the blood which results from the tear has to find its way to the surface of the body. Indeed, not uncommonly, the bruis-

ing which results appears some distance from the site of the original injury. This is because the blood finds its way between various muscles, often through the influence of gravity, and appears therefore much lower down the limb. No description of strains would be complete without referring to the less dramatic type which may occur through undertaking repeatedly a variety of work to which the muscle is not accustomed. Thus, the author of this article suffered from a severe strain of the leg through leaning over a double bed when attending a patient and keeping his legs too straight. Strains, of course, are not the only injuries that can occur to muscles. Tendons can be cut as a result of wounds and sometimes they give way spqntaneously as a result of a sudden exertion. An unpleasant accident, for example, is rupture of the tendo-achilles, the thick fat tendon which can be felt easily behind the ankle. This accident results in almost complete loss of use of the foot and may require an operation for its cure. Sprains These injuries affect the ligaments which bind together the bones at each j oint. They are strong bands of white fibrous tissue forming a covering round the joint but strengthened in various situations by elastic bands. Some joints, in addition, have ligaments within them, for example, two ligaments in the form of a cross are found in the knee joint. When a ligament is stretched or torn the injury is called a sprain. It is often combined with a tearing of other tissues in the vicinity. A sprain can, in fact, be nearly as painful as a fracture or dislocation and neglect to treat it properly may result in permanent weakness of the joint. The diagnosis of a sprain may be difficult to make. There is a history of violence in the form of a wrench or twist and the patient may even have felt something give way. Since sprains always occur at joints they are liable to be confused with fractures. The pain is of a dull aching character and becomes more acute if the joint is moved in such a way that the injured ligament is put on

the stretch. Naturally there is loss of power but never so extreme as in fra~tures. Swelling and bruising are vanable features. If the injury is recognized early and the limb kept raised, neither may ever develop. The diagnosis rests on excluding more serious injuries such as fractures and dislocations and in this connection it must be emphasized that if ever tenderness is found on a bone, a provisional diagnosis of a fracture should be made and it is for the doctor to exclude it by X-Ray or other examination. It is easier to distinguish between a sprain and a dislocation since fixity of the joint is present in the latter injury, whereas the joint will move satisfactorily in a sprain-although it causes pain to the patient-which, however, can be greatly alleviated if the patient is told to let his joint go as limp as possible and to allow all the work of movement to be done by the first-aider. It will be noticed that no treatment is being advised for the various injuries described in these articlesexcept in exceptional cases. The reason is that treatments vary according to standard first aid methods and also even amongst the doctors. It is far better, therefore, for the student to adopt the method which he has been taught and to which he can refer in his text-book unless he has specific instructions to the contrary.

Books 'Bailliere's Nurses' Medical Dictionary,' by Margaret Hitch, S.R.N., 13th edition., Bailliere, Tindall & Cox, price 6/-. This dictionary becomes more comprehensive with each new edition; but owing to the fact that it is now printed on thin paper its size has remained small enough for it to be carried in the pocket or handbag. It was compiled especially for nurses, although all auxiliary services of the medical and nursing professions find it equally useful. An amazing amount of accurate information is compressed into its pages, which now number 500; and the frequent revisions which it has undergone has enabled this information to be kept up to date. Undoubtedly, it is a book which no one interested in nursing, first aid or civil defence can afford to be without.-A.E.P., S.R.N., Diploma in Nursing (University of London).

FIRST AID & NURSING, MARCH/APRIL 1954

INDUSTRIAL FIRST AID-3

British Railways an historical sense the main line I N railways have had a p~op~rly constituted ambulance orgaruzatIOn for well over half a century, an?, following the nationalization of raIlways as from 1st January, 1948, there is now one set pattern for the whole of British Railways.. . . The Ambulance OrgaruzatIOn III England is conducted under tb.e auspices of the St. John Ambulance Association, in Wales under the Priory for Wales and in Scotland under the St. Andrew's Amb:ula?ce Association. Questions of pnnciple relating to the activities of the Ambulance Organization are dealt with by the Headquarters' Committee on First Aid Matters presided over by the British Transport Commission's Principal Staff Officer. The main purpose of the or~aniz ation is the training of the staff III the principles of first aid t? ena~le them to deal with emergencIes whIch may arise in the course of their work.

Organization

In such a large undertaking ~s British Railways, it will be appreciated that to enable the Ambulance Movement successfully to carryon its activities there must be a lar~e body of energetic workers. To thiS end each of the six Regions has a Regional Ambulance Secretary who is responsible for t~e cOl~duct of ambulance work in hIS ReglOn, and each Region is divided into districts, with a District Ambulance Secretary appointed in each District i.n ~n honorary capacity. The DIstnct Ambulance Secretaries are responsible to the Regional Ambulance Secretary for activities within their respective Districts, and Class Secretaries administer all class arrangements. The Districts are also. sU.bdivided into areas, and DIstnct Committeemen are elected to represent the various areas. Headquarters and other Committees function for the purpose of dealing with the

FIRST AID & NURSING, MARCH/APRIL 1954

many problems :v~ich a~ise. Representatives of BntIsh Railways also serve on the St. John Ambulance Association Committee. Each Regional Ambulance Organization is well sustained .in its efforts by the active co-operatIOn of the Officers, and is partic~larly indebted to: the Chief RegLOnal Manager (President), the Regional Staff Officer (Chairman), and the Regional Medical Officer (Medical Officer). Voluntary Basis The Railway Ambulance Movement is conducted on a voluntary basis both in regard to training, which is undertaken in the employees off-duty hours, and the services rendered by District and Class Secretaries and others interested in the work. Tuition, text-book, accommodation for classes and all necessary equipment are, however, provided free. Facilities are also granted, if necessary, to enable students to travel to and from class centres. While it is necessary that there should be a refreshment of new candidates to the ambulance movement, the work is well maintained and approximately 20,000 emplo~ees pass examinations and re-exammations each year. With the view to stimulating interest, a series of First Aid Competitions, including a Women'.s Competition, are h~ld .annu.ally 111 .each Region, culmmat111g m NatIOnal Competitions held by St. JO~lll Ambulance Association. The wmners of the National Competitions also take part in the Grand Prior's Trophy Competitions. Trophies and valuable prizes are awarded to successful teams in the railway competitions. . . A scheme is also m operatlOn whereby meritorious first aid rendered in cases of serious illness or injury is recognized by t~e award of a special certificate and, 111 the.more exceptional cases, by the grant111g of a further and higher award. Outstanding Service Every effort is, of course, made to minimize the risk of accident on the railways, but, as in the case of other forms of transport where men have to contend with moving machinery and vehicles, there are hazards to be faced, but it can be truly said that in

equipment, and for ensuring that it is well maintained and available when required. Considerable thought has been given in recent years to the standardization of ambulance equipment, including equipment which is provided in all passenger trains, with the view to seeing that tirst aid personnel are provided with the essentials for carrying out treatment according to the various emergencies which may occur. In this review the question of the establishment of well-equipped first aid treatment rooms has not been overlooked, and new buildings have been provided, or are in course of construction at many places.

First Aid room at Bristol B3.th Road, Motive Power Department

times of emergency British Railways' First Aid personnel have always given outstanding service in the saving of life and the relief of suffering. The following are recent examples of their coolness, courage and resourcefulness in time of need :-

personal safety. Complete immobilization in a Neil Robertson stretcher was admirably carried out, and every precaution taken to avoid further injury and to treat shock. The removal to hospital was also ideally carried out.

As a result of salvage operations, a burnt-out Danish vessel was raised from a river bed at a sea port, and had a list of 20 degrees. During the watch which ensued, a man fell into the hold. A British Transport Commission Police Sergeant went to his aid, and found him lying in mud and slime suffering from pain in the region of the spine and considerable shock. The angle of the vessel and conditions aboard made proper examination impossible, but after great difficulty the patient was carefully harnessed to a Neil Robertson stretcher, and subsequently removed through apertures to the upper deck-a matter of 50 ft.-and thence to the quay and waiting ambulance. The Police Sergeant took a major part, and successfully directed others in this delicate operation, which was fraught with danger to the patient and themselves.

An Operating Department Inspector and two Engine Drivers went to the aid of a Ganger who was knocked down by an engine, his right arm and both legs being run over and severed; there were also bruises to the head. Although strangers to each other, the three firstaiders worked as team, using improvised tourniquets, lint and dressings. No time was lost in the treatment of the patient and his prompt despatch to hospital. The doctor at the hospital said that the speedy and efficient first aid rendered was a life saving measure. On admission the patient's condition was remarkably good, and he was thus suitable for the extensive surgery then performed. The Ministry of Transport Inspector also paid high tribute to the first aid rendered and said that as a result of the efforts of the men concerned the patient had made a remarkable recovery.

The Doctor who was present said that the removal of the patient had been carried out in an exemplary manner, and without regard to

Apart from training in first aid, the Ambulance Organization is responsible for the provision of all

Equipment

Exercise for Civil Defenders from Government Departments Five derelict houses in Regency Place were the scene of an incident staged by the Westminster City Corporation as an exercise for Civil Defence members in the Government Offices. The premises were dilapidated, not war damaged, and the rescue men had to deal with the hazard of floors grown rotten and broken by age and there were some nasty holes. Walking casualties were assisted to a mobile First Aid Post set up on the pavement nearby. Other cases were brought down on stretchers including ladder sLide. The casualties who were portrayed by members of Casualties Union under the leadership of Mr. P. G. Sargeant provided problems in reconnaissance, diagnosis and detennination of priorities. They included cases of closed fracture of arm, fracture of leg, internal haemorrhage, punctured wound of chest, complicated fracture of ribs, facial cuts with hysteria, fracture of collar bone, facial burns and lacerated legs. The casualties were all briefed to be local people so that experience could be gained in accounting for missing persons. The dirt, grit and dust of the dilapidated properties added greatly to the distress of the 'casualties' and emphasized how important it is to prevent the distress and danger caused by flicking muck and grit into the faces and wounds of patients found amid the dirt, dust, gdt and glass of debris-littered premises. Aids to the Disabled The British Red Cross Society recently held a one-day exhibition of ' Aids to the Disabled' and demonstrated a wide range of gadgets for helping the disabled to perform such essential actions as cutting bread, pulling on stockings, picking up objects from the floor, knitting and writing. There are very many of these appliances for all sorts of uses. For example, a longhandled shoe-horn and grip; long-handled washing aid; tap-turner on; periscopic glasses; page-turner; drinking and eating aids; bath grip, and much ~lse. The Red Cross say that they are anxlOUS to a~d to this collection, and anyone who has Ideas should get in touch with Miss E. K. Skinner, Home Department, 14 Grosvenor Crescent, London, S. W.1.

FIRST AID & NURSING, MARCH/APRIL 1954

Notes on advanced physiology By F. C. Reeve F.Z.S., F.R.E.S. Although the heart contains nerve cells and is served by a number of nerve branches from the C.N.S. (central nervous system), yet the rhythmic beat of the heart, strange as it may seem, is not controlled by these but by a stimulus which is inher~nt in the cardiac muscle itself. This has been proved by detaching from a living heart a portion of cardiac muscle and placing it under the microscope, when it was found that, 'provided the muscle be we~ supplied with oxygenated blood, ~t will continue to contract rhythIDlcally for some time, even for hours under favourable conditions. It will here be noted that the heart muscle cannot function unless it is well supplied with oxygenated blood, a fact which emphasizes one of those correlations referred to earlier in this article, for it will be remembered that it is in the lungs that the blood obtains the necessary oxygen. Perhaps we cannot do better than try to follow the sequence of events, which together go to make the heart beat (cardiac cycle). Venous blood, as you have learned from your textbooks, is emptied into the right auricle from the superior and inferior venae cavae, passing on to the right ventricle through the auriculoventricular orifice which is guarded by a valve (tricuspid valve), the flow from auricle to ventricle being assisted by the contraction (auricular systole) of the muscle of the auricle. At the same time the blood from the left auricle is flowing into the left ventricle through a similar orifice which is also guarded by a valve (mitral valve). The pressure required to force blood from auricle to ventricle is not great, so that it is unnecessary for the walls of the auricles to be very thick. The next stage in the progress of the blood through the heart, however, requires considerably more pressure, for it has to meet with a much greater resistance. The blood from the right ventricle is forced past the semilunar valve guarding the entrance, through the pulmonary artery into the lungs as a result of the

contraction (ventricular systole) of the right ventricle. A similar series of events is taking place at the same time on the left side of the heart, the left auricle contracting with the right one driving the- blood into the left ventricle, and the left ventricle contracting with the right ventricle, driving the blood into the aorta, which is guarded by another semilunar valve. In order to give some idea of the rapidity with which these events take place it will be noted that the auricular contraction (auricular systole) takes one-tenth of a second and the ventricular contraction (ventricular systole) three-tenths of a second. This muscular exertion is followed immediately by a pause (diastole) of four-tenths of a second. One or two points in this sequence of events need SOllic little explanation. Why is there practically no reflux of blood from the right auricle back into the venae cavae? Near the entrances of these vessels into the auricle there is a mass of specialized tissue (sino-auricular node) which is endowed with qualities somewhat akin to those of a nerve centre, and it is here that the contraction of the auricle commences, passing in the form of a wave, which is, however, almost instantaneous, over the muscle of the auricles. The stimulus is then transmitted to the ventricles by way of the ' bridge' formed by the bundle of His, and the wave of contraction then passes over the ventricles. As this wave of contraction commences at the sino-auricular node near the entrances of the venae cavae, these are made to contract and so prevent the backward flow of blood. Another question which might arise is 'What prevents the flaps (cusps) of the tricuspid and' mitral valves from being forced right through the orifices into the auricles when the ventricles contract ?' Rising from the walls of the ventricles are a number of tiny muscular pyramids (papillary muscles). Attached to these, and extending to the edges of the cusps are a similar

number of tendinous threads (cordae tendinae). Upon each contraction of the ventricular walls these pyramids of muscle also contract, supplying with the chords just the right tension to prevent the cusps from being forced into the auricles. Sometimes the bundle of His becomes impaired by disease, resulting in a very serious condition known as ' heart block' in which the auricles and ventricles fail to maintain their corresponding rhythm. You will often meet with this morbid condition in the medical wards, and if you do get an opportunity of studying it you will find it very interesting.. If a stethoscope be placed over the region of the heart of a healthy subject the careful observer will hear two distinct sounds, although the second follows so rapidly upon the first that they are very difficult to detect, except by the trained ear. The first is a rather dull thud, and has been likened to a person saying 'doob.' The second is sharper and more staccato, sounding more like 'dup.' The first sound is the result of two separate causes, viz., the closing of the tricuspid and mitral valves and sudden contraction of the ventricular walls. The second sound is caused by the sudden closing of the semilunar valves at the end of the systole. Should any of these valves be impaired by disease the sharper sounds are replaced by a hissing or blowing sound.

Although the distribution and functions of the various arteries and veins must form the subject of a later article, this section would be incomplete without reference to the portal circulation. The portal vein, only 3 in. long, collects up the blood from the various organs of the abdomen, but particularly from the digestive tract, and empties it into the liver, from which it passes to the inferior vena cava for delivery back to the heart. It will be seen how dependent the digestion is on a perfect circulation of the blood.

FIRST AID & NURSING, MARCH/APRIL 1954

, He told me I had blood pressure' said a patient as she emerged from the consulting room. How often we hear this remark. If that good lady had no blood pressure she would be in a very bad way. What the doctor had probably told her was that she had high blood pressure. What, then is blood pressure ? It is nothing more nor less than what is actually indicated by the term itself. Attach the garden hose to the water-tap and turn on the tap to produce a moderate flow of water, when it wjU be discharged at the other end a few inches from the hose. Now attach to the free end a nozzle, without altering the flow from the tap, and it will be found that the water will be projected some distance from the nozzle, perhaps, even, some yards. Turn on the tap still more and the length of the stream of water will be increased, but turn it nearly off and the stream wiU almost disappear. It will be obvious, also, that the water inside the hose must be exerting a certain amount of pressure against the walls of the hose, but the amount of this pressure will be governed by four factors, viz., the force with which the water leaves the tap, the ' give' or elasticity of the rubber walls, the resistance set up by the Iiozzle and the total amount of water available. This is exactly what is taking place in the arteries of the body. The aorta corresponds to the hose and receives the blood which is pumped by the heart, the elastic nature of its walls assisting in pushing the blood forward, but the smaller arteries into which the aorta breaks up sets up a resistance corresponding to that set up in the hose pipe by the nozzle, so that, if an artery is cut it is seen that the blood spurts out to a considerable distance. It will be noted, however, that at intervals the blood from a cut artery spurts to a greater distance, corresponding to the beating of the heart. Between the beats the pressure in the arteries is maintained by their elastic walls, so that we find that there are two distinct degrees of pressure. The greater pressure, resulting directly from the pumping action of the heart is known as the systolic pressure, but the lower pressure, maintained by the elastic walls is called the diastolic pressure because it is maintained during the resting period (diastole) of the heart. It is the former, however, which concerns

the doctor when he tests your blood pressure. This is done by means of an instrument called a sphygmomanometer (if you accent the' nom' you will experience little difficulty in pronouncing this word), which you have all seen on the doctor's desk. A wide rubber tube is wound round the limb, usually over the brachial artery, and this is connected by a small tube to a gauge containing a column of mercury, in appearance somewhat like a thermometer. The blood pressure is measured against the weight of the mercury in the gauge, which is marked in millimeters, and the result is recorded as so many millimetres of mercury, or mm.Hg., Hg. being the chemical symbol for hydrargyrum or mercury. The blood pressure varies with age, but it is usually considered that it is equal to the age of the person in

years plus 100, so that the blood pressure of a person of 20 years of age should be, roughly, 120 mm. Hg., although there are certain modifying factors taken into consideration by the examining doctor. The difference between systolic blood pressure and diastolic blood pressure is called the pulse pressure. Like the water in the hose pipe, four factors govern blood pressure : 1. The force with which the blood is pumped into the aorta. 2. The resistance set up by the smaller arteries (peripheral resistance). 3. The elasticity of the artery walls. 4. The total amount of blood circulating in the whole body. The viscosity of the blood, however, is by no means unimportant.

Mobile dispensary for Persia" G •• lf

Before it left for Dubai, on the Persian Gulf, the mobile dispensary seen here was inspected by the Countess of Limerick, Vice-Chairman, British Red Cross Society, and Miss Evelyn Bark, International Relations Adviser, at the Society's London headquarters. The vehicle will be operated in remote areas by Mr. Arnold Plummer, a British Red Cross officer from Dorking, under the supervision of the Dubai hospital. The vehicle is a 4-wheel drive Land Rover which has been modified and equipped as a mobile dispensary by the Wimbledon firm of Messrs Pilchers. Features include insulated

roof, special ventilation, built-in washing facilities, fresh water supply from Polyth~ne tank fitted cupboards for drugs, dresslDg and 'splints. The nearside body interior is fitted with a folding stretcher gear, and additional accommodation is provided by a tent which fastens on the rear of the body when the doors are open, and the dispensary is in operation. Special mattress devices are provided for putting under the wheels to prevent them sinking in shifting sand patches, and hooks are fitted on the body sides for carrying the traditional water skins used in the desert area of operation.

FIRST AID & NURSING, MARCH/APRIL 1954

St. John Cadets

Competitions 'THE boys and girls of to-day are the men and women of tomorrow.' If ever evidence of this old saying were required it could have been adequately furnished at Southwick on Saturday, 6th March, when the St. John Cadets-the st. John Ambulance men and nurses of the future-demonstrated their knowledge and skill at the Annual County (Sussex) Cadet Eliminating Competitions held under the auspices of the St. John Ambulance Brigade. Those crack teams, of which the senior section of the organization is so proud, will certainly have to look to their laurels when these young people are old enough to be transferred. It was obvious that those responsible for setting the tests had anticipated a high standard of efficiency, and in this they were not disappointed. A feature which has latterly been introduced into the senior competitions has been the , nuisance,' staged for the purpose of testing the tact and phsychology of the competitors when called upon to deal with unexpected and embarrassing interruptions. This feature has been extended to the Cadet competitions, and the manner in which these young people dealt with such , nuisances' as the distracted mother coming in to find her child scalded, the hysterical young sister who believed that she would be blamed for the accident and the houseproud middle-aged householder who endeavoured to recover her blankets which she thought might be blood-stained and who objected to the boys bringing their patient into the house without removing their dirty boots, was deserving of the highest commendation. One boy caused considerable amusement by 'cheeking' the housewife into submission, just as a boy would. Following are the tests set for the various classes , and they are well worth comparing in difficulty with those we have been seeing set for adult competitors. Moreover, they are well worth working through in class, both by senior and junior divisions. THE TESTS Senior Nursing Cadets, Team Test : Card: One lovely summer's evening, the night before this competition, you are going to a special practice under the Superintendent at Headquarters. Just before you reach the building, the door of a house flies open. Act as you should. Scene.' The setting is a small room with a bath of hot water standing in front of an empty grate. The idea is that a small child about to have a bath falls over it, getting superficial (lacerated) wounds on both shins, and scalds on both arms and face. Junior Nursing Cadets, Team Test: Card: You four are on your way to a competition, when you see a crowd has collected and realize a house is on fire. The Fire Brigade has arrived. Should anythin~ occur, act a~ you should.

Scene: House. A lady runs out very agitated and coughing, tells firemen that her husband is inside. She cannot rouse him and believes he is dead. Firemen carry man out on mat and leave him in charge of team. Note: Man has suffocated by smoke, has burns to right hand, and simple fracture right femur. Their married daughter lives nearby. Junior Ambulance Cadets, Team Test : Card: You are walking along a deserted street when you hear a crash and a cry for help. Turning the corner you come upon the scene as it is shown. Act as you would. Time allowed 15 minutes. Setting: Outside a house. A window cleaner has fallen, together with his ladder. He is lying with one leg caught through the rungs. He has a laceration of the right wrist ",ith a large splinter of wood, from the ladder, embedded. He has a fractured right knee-cap. The only available helper is the householder. She is middle-aged, crotchety and not too co-operative. Use of the telephone is grudgingly permitted, but suggestions that the patient be carried into the house meet with obstruction; likewise facilities for blankets, etc. are only made after argument. Marks are given for handling this person, as well as the patient. The competitions were watched by a large and enthusiastic audience, despite the fact that Southwick is five miles from the nearest large towns of Brighton (with Hove) and Worthing, demonstrating the increasing interest being taken by the general public in these important subjects to-day. Shortly after five o'clock, as soon as the judges had had time to study the marking sheets and assess the respective marks, the crowd moved to the main hall, where Maj.-Gen. J. M. L. Renton, C.B., D.S.O., O.B.E., the County Commissioner, took the Chair, supported by Mr. E. E. Thornton, Chairman of Southwick Urban Council, who was to present the trophies. Maj.-Gen. Renton said that he had been very pleased that afternoon to note the high standard of work carried out by the Cadets, and especially to note the large number of entries -over 100 competitors in 20 teams. It was a tribute to the organizers. He then had great pleasure in asking Mr. Thornton if he would kindly present the trophies. Mr. Thornton said that he rose with a great sense of pride. Southwick girls had carried everything before them. The senior team had won th~ Senior Bessborough Cup, the junior team had won the Junior Bessborough Cup and the Trotter Cup for the highest number of points scored by a team leader had gone to their junior team. For the third year in succession their Junior team had carried off the Junior Bessborough Cup. He was quite sure that he would be forgiven for feeling proud of the Southwick girls, an announcement which was greeted with tremendous applause. He had always taken a great interest in the ambulance movement, and it had given him great pleasure to welcome the competitors this year to Southwick. 'What a wonderful training and what a wonderful start in life

FIRST AID & NURSING, MARCH/APRIL 1954 3.

is being given to these young people' he said. 'Complaint is often heard' he continued, 'that children are not what they used to be, but those who have been here this afternoon will surely alter their opinion.' Mr. Thornton then presented the awards as follows :Senior Nursing Section : The Bessborough Cup to the winning team, Southwick. The Scott Cup for the highest number of points scored in individual tests, Hangleton. Junior Nursing Section: The Bessborough (Junior) Cup to the winning team, Southwick 'A' (third year in succession). The Trott Cup for the highest number of points scored by a team leader, Southwick , A.'

Letchworth, Herts (296-H (winners of the New ?-~aland .Challenge Cup, for the team gamlOg hIghest marks in the Individual section).

Ambulance: Junior. Max. 400 .' 1. Fairbairn House, London (302) (winners of the Schooling Challenge Cup for the team gaining highest marks, and of the Jarvis Cup for highest marks in the Individual section). 2. Dean & Chapter Colliery, Durham (296). 3. Worthing, Sussex (291t) (Stalybridge, Cheshire, won the Barne Cup for the team gaining highest marks in the Team Test).

Nursing.' Senior. Max. 400 .' 1. Paignton, Devon (281) (winners of the Mountbatten Challenge Cup for the team gaining highest marks in all tests). 2. Harrow, London (277!) (winners of the Pownall Cup, second highest marks all

t~ts; the Senior Individual Cup for highest marks in the Individual section: an~ .the Bedmaking Cup, for the team gamlllg highest marks in the Bedmaking section). Tredegar, Wales (269).

Nursing: Junior. Max. 400 : 1. Stockton & Thornaby, N. R. Yorks (272t) (winners of the Dunbar-Nasmith Challenge Cup for team gaining highest marks all tests). 2. Torquay, Devon (271i) (winners of the Cunar~ Cup for team gaining highest marks ill the Individual section, and the Tweedale Trophy for highest marks in the Home Nursing Section, Individual tests). 3. Saltwood, Kent (258-!). The Edwin King Special Service Shield was presented to Clevedon, Somerset Ambulance Division. This Shield is awarded annually to the Division which attains the greatest number of Special Service Shields during the year.

The Sussex Cup for the highest number of marks scored in individual tests, Rye. Junior Ambulance Section: The Hinckley Cup to the winning team, Lancing' A.' The Trotter Cup for the highest number of marks scored in individual tests, Lancing 'A.' The County Commissioner then paid tribute to the very great interest shown in the movement by the medical and nursing professions, and especially to those who had so kindly consented to act as judges that afternoon. They were: Dr. R. Matthews (Senior Nursing Team), Mrs. Johnson, S.R.N. (Senior Nursing, pairs), Mrs. Morris, S.R.N. (Senior Nursing, individual), Dr. Oyler (Junior Ambulance team), Insp. McLean (Junior Ambulance, pairs), Sergts. Newell and Griffin (Junior Ambulance, individual), Dr. D. Duncan (Junior Nursing, team), Sister Tutor Miss M. Gurr, S.R.N. (Junior Nursing, pairs), Miss E. Parks, S.R.N., and Miss B. Smith, S.R.N. (Junior Nursing, individual). A vote of thanks to the organizers, County Secretary, Mr. Simpson, County Cadet Officers Miss E. M. Trill and Mr. F. W. Dallen, the 'casualties,' stewards and all those who had so ably assisted brought to an end a really full afternoon.

Finals The final of the first aid competitions for St. John Ambulance Brigade Cadets took place at the Central Hall, Westminster, on 20th March. Results were : Ambulance: Senior. Max. 400 : 1. G. E. C. Witton, Birmingham (299-D, (winners of the White Knox Challenge Cup for the team gaining highest marks). 2. Stain forth & Hatfield Main, W. R. Yorks. (299) (winners of the Pownall Cup for the team gaining second highest marks, and of the Lowe Cup, awarded for highest marks in Team Test).

Stanley Shield Eliminating Rounds As the Great Day draws near excitement approaches fever heat in the realm of the British Red Cross. Which detachment will be the proud one to welcome back the winners of the coveted Stanley Shield on 22nd May next ? Two of the eliminating rounds were held in London on Saturday, 27th March, and were keenly contested by five teams at the City of London Branch Training Centre and seven teams at the County of Londo~ Branch Headquarters. The tests, which were divided into three part~, disclosed a very high standard of effiCIency, and the narrow differences betweer: the marks obtained by the various competmg team~ suggest that the judges were presented WIth no easy task. A total of 1,000 marks was possible, allotted as follows : Part I: Individual First Aid oral 75 In~vidual First Aid,'practIcal ... ,.. ... 155 Individual Nursing, oral... 75 Ind.ividual Nursing, practIcal ... 155 Part II: Team Test, First Aid 230 Team Test, Nursing 230 Part 111: Uniform ... ... 80 . The .team test, which was of a most Inter~tlllg character, and well worth workIng through by detachments, was as follows : . The incident takes place in the small VIllage of Bow on a fine summer's evening. The Commandant of the local detachment and four of her members are having a practice in her house when they hear calls for help from over the road where an old lady, Mrs. Box, lives with' her daughter Ethel at IV!' Cottage. They find that Miss Loop, a fn.end who has been helping with some cookmg, has upset a pan of boiling water over the front of both her legs and feet. In attempting to steady herself she has p~t her left hand on the hot stove. Miss B?x IS also injured in rushing to help her fnend.

Injuries to be treated .' Miss Loop: Severe scalds, both legs, left .leg below knee and over instep, right leg Just above ankle and over foot. Severe burn palm of left hand. Severe shock. Ethe~ Box: Colles' fracture, right, simple. Sprallled ankle, left. Moderate shock. Mrs. Box: Unhurt, but agitated and makes a nuisance of hl:rself. Card of instructions f or team: You are Commandant of a detachment in the small village of Bow. On a fine summer's evening you and four of your ~embers are having a first aid practice III your house when you hear calls for help from over the Toad, where an old lady, Mrs. Box, and her daughter Ethel live at Ivy Cottage. You go to investigate. Telephone is in your own house, hospital and ambulance 5 miles away. At home you have F.A. haversack, 1 stretcher and 3 blankets. Two doctors (partners) are 5 miles away. The results of the respective rounds were as follows: (1) Sussex (745t), (2) Surrey (721), (3) Norfolk (690), (4) Middlesex (678), (5) ~ssex (666). (1) Kent (718t), (2) Cambnd&e (703), (3) Oxford (701), (4) Isle of WIght (666 -n (5) Herts (659-!-), (6) Notts. (653), (7) Suffolk (622t), Sussex and Kent will compete in the Final. In announcing the results, special thanks were passed to the judges who had so kindly given their time and knowledge in this great cause. They were: Dr. H. N. C.ollier, Surgeon Commander P. Turtle, SIster L. Blaney, Dr. P. Lomax, Dr. E. Walwyn-Jones, Miss E. Gower, Sister M. Davies, Miss M. Naylor-Smith. Dr. G. D. Pirrie, Dr. J. C. Evans, Miss B. M. Robertson, Dr. M. S. Stuart, Dr. C. W. Robertson, Sister M_ L. Noble, Mrs. M. Dare Bryan, Miss M. Young Jamieson. Credit must be given to Mrs. Hetherington, Staff Officer at Headquarters, Mrs. Prentice, Branch Director, and Miss Graham-Campbell, Branch Secretary, whose organizing work had contributed so largely to the success of the events.

CASUALTIES UNION Vice-President Lt.-Gener~l Sir Otto Lund, K.C.B., D.S.O., Chief Commissioner, St. John Am.bulance. Brigade, has accepted office as a VIce-PresIdent of the Union.

Television . The .B.B.C. . has been broadcasting an mterestmg senes of items 'About the Home,' on alternate Thursday afternoons to demons~rate the cause and treatment of sunpJe aCCIdents. It is hoped that this will have a direct result in preparedness to deal with such accidents and also an awareness to . prevent them occurring. Casualties Uillon co-opera!ed with the Royal Society for the PreventlOn of Accidents and The British Red Cross Society by providing a , casualty ' each fortnight; a girl who had been burnt because the skirt of her dance frock caught fire (Miss Margaret Row of Southampton); an elderly lady with a closed fracture of the forearm (Mrs. McCarthy of Reigate); a man who was asphyxiated by coal gas (Ken Cartland of Egham). Dr. Collier instructed and Joan Gilbert carried out the first aid. A sequel to one of these broadcasts occurred when a small girl who had seen the demonstration had the misfortune to catch her clothes on fire. She remembered the drill, ext~guished the flames by lying down and rollrng herself in a rug and so saved herself from more severe injuries. This incident alone shows the power of the , trained casualty' to present training in a vivid and memorable manner. Civil Defence An interesting

endeavour was made recently to bring all aspects of Civil Defence to the public by means of another live television broadcast (Saturday evening, 13th March). It was an amphibious exercise and all the services associated with Civil Defence co-operated. Casualties Union provided 30 casualties. The night turned out to be wet and cold but nevertheless the proceedings went through without a hitch. Richard Dimbleby, the B.B.C. commentator, reminded his audience that the Union was providing a much needed service of trained casualties to assist Civil Defence in many parts of the country. Dr. Glyn Hughes, the Senior Medical Administrator of the South-East Metropolitan Regional Hospital Board and President of the Union, described the work of the hospital services and the mobile units of the ational Hospital Service Reserve. Wing-Commander Sir John Hodsoll, Director-General of Civil Defence wound up the proceedings. Sir John is a Vice-President of Casualties Union. If volunteers could be assured of realistic training throllghout their service with Civil Defence there is little doubt that many more recruits of good calibre would come fOllvard and that absenteeism would shrink to a minimum. Realism can produce most satisfactory results from very modest beginnings, once trained' patients' become available. (Continued Oil page 15)

FIRST AID & NURSING, MARCH/APRIL 1954

LETTERS

NURSING NOTES

FIRST AID & NURSING, MARCH/APRIL 1954

SOMETHING ENTIRELY NEW

THE EDITOR,

First Aid and Nursing. Dear Sir, In her excellent article on the place of the nurse and the first-aider in industry in your Jan. /Feb. issue, Nurse Agnes Pavey refers to the fact that the person responsible for the factory first aid box must be trained in first aid treatment and goes on to say that the ' recognized first aid training is that of st. John Ambulance Brigade, the Britis? Red Cross, St. Andrew Ambulance AsSOCIation, the police or one of the armed services.' In fact there are no standards of training laid down for those who are placed in charge of first aid boxes and whilst it is true that it is frequently found that the certificates mentioned by Nurse Pavey are held by those in charge, there is no obligation on the pa~t of the employer to ensure that such certIficates are held. At a conference in July 1953 of the Occupational Health Section of the Royal Coliege of Nursing, Dr. Norman MacDonald, Senior Medical Officer, Lever Brothers, Port Sunlight, expressed the view that the Minister of Labour could, without new legislation, raise the whole standard of medical treatment in industry by defining the , responsible person' as one who had gained specified first aid certificates and thus reached a given standard of efficiency and knowledge. This Institute has, since its inception in 1946 advocated raising the standard of amb~lance and first aid training and we consider that in industry today it is essential for those in charge of first aid boxes to be specially trained for the job. Our own Final (Fellowship) Examination syllabus has a special section devoted to industrial first aid in addition to sections on general first aid, and it is our view that those in charge of first aid boxes should have reached a standard of efficiency and knowledge not less than that required to gain our Fellowship. That is why we are asking the Minister of Labour to consider the proposal made by Dr. MacDonald and to make an order defining what training should be given and what standard reached. Yours faithfully, NANCIE E. BERGER, O.B.E. General Secretary. THE INSTITUTE OF CERTIFIED AMBULAN CE PERSONNEL, 5 GROVE TERRACE, LONDON , N. W.5 .

24th March, 1954. Courses and Conferences at Barnett Hill, Wonersh, near Guildford, Surrey No. 305.-Instructors' Course.-June 17th to 21st. Open to all Officers and Members who are eligible to attend. See Revised Instructors' Course, para. 77. An examination will be held at the end of the Course. No . 306.- Section Leaders' and Members' Course.- June 25th to 28th. This Course is intended to give a wider knowledge of the Red Cross.

Prevention of Poliomyelitis The precautions that were taken in Western Australia to protect the Royal Party from possible infection by po~io myelitis have led to conSIderable diSCUSSIOn among the general public regarding the nature of the infection and the avenues through which it can be transmitted. The disease is due to a virus- an organism too small to be seen under a microscope and capable of passing through the finest unglazed porcelain filter- but its presence can be demonstrated by the injection of filtrates into laboratory animals such as the guinea pig, which then develops the disease. The virus can be isolated from the nasopharynx of infected persons for several days, and from their stools f?r seve~al weeks. Family contacts of patIents wlth poliomyelitis are often found to be carriers of the virus, which they can inadvertently convey to other people although they themselves do not develop the disease. Carriers play a greater part in the spread of the infection than do the patients themselves, for the latter are surrounded by safeguards whilst it is possible for the former to convey the virus to anything he handles, or to transmit it by personal contact or by droplet infection. The ultimate control of the infection would seem, therefore, to depend upon widespread immunization. Immunization by Gamma Globulin Research in the United States has led to the development of a method of immunization which, although still in its experimental stage, holds out a real hope of controlling the spread of poliomyelitis. The substance used is gamma globulin, derived from blood plasma by a chemical fractional process. Controlled tests were first made in 1952, during an epidemic; and it was claimed that gamma globulin conferred an immunity against poiliomyelitis for about five weeks. During 1953, gamma globulin was used in 18 districts where severe epidemics of poliomyelitis were a seasonal occurrence. It was offered to all members of the family of a person who had developed the disease who were under thirty years of age; and it was also available in camps where the disease had occurred, and other places where people lived in close association with each other. During this year it is hoped that supplies of gamma globulin will be, at least, twice as great as during 1953, for it has been noted by investigators that blood plasma remains as useful for transfusion, after gamma globulin has been extracted, as it was before. Studies are now in progress to improve the methods of production and also to develop some vaccine, or other substance, that will give a longer period of immunity. At present, although gamma globulin appears to be efficient in controlling the spread of an epidemic that has already started, it does not confer an immunity that is carried over to another season, and, therefore, it cannot be regarded as the final answer to the problem of poliomyelitis.

A Training Scheme for Hospital Cooks A national apprenticeship scheme for the training of hospital cooks is shortly to be introduced into the health service. It has been drawn up by the Ancillary Staffs Whitley Council, which has set up a National Joint Apprenticeship Committee authorized to approve hospital establishments capable of giving proper training, to register both male and female apprentices who are accepted as suitable, and generally to ensure that a high standard of training is maintained. Apprentices can be received from the age of 15-16 years for a period not exceeding five years. Their training will cover all aspects of cookery and will include a studyday each week at a technical college, or its equivalent, leading to the City and Guilds of London cookery diplomas. If they wish, male apprentices may secure deferment from National Service until their apprenticeship is completed. Although all hospital authorities have been invited to participate in this scheme, the Minister of Health has pointed out that only one or two hospitals in each area should become training centres if the best type of training is to be provided; and he acknowledges the value of shorter apprenticeship schemes which have been established in a number of hospitals durin g recent years, and which have produced apprentices whose skill and knowledge have been well demonstrated in competitions organized by the Catering Industry. These hospitals are invited to adapt their course of training to fit into the new scheme. Florence Nightingale Commemoration Day This year marks the centenary of Florence Nightingale's expedition to the scene of the Crimean War. On her birthday- May 12- special services will be held in many churches, including Westminster Abbey and St. Paul's Cathedral. The service in the Abbey is being organized by the War Office. Troops and their bands will be present, and Whitehall will be lined by contingents of nurses. The service in St. Paul's Cathedral is at 6 p.m. and it is being organised by the National Council of Nurses of Great Britain and Northern Ireland. Her Royal Highness the Duchess of Gloucester and the Lord Mayor of London will be present. Small flags bearing the lamp of Nursing will be on sale on May 12th. The money obtained from these and from church collections will go to the Florence Nightingale National Memorial Committee and will be used towards the endowment of Florence Nightingale International House. This is a hostel for nu rses holding scholarships awarded, for postgraduate study, by the Florence Nightingale lnternational Foundation, which is intended as a permanent memorial in this country to the work of the great pioneer. Commemoration in Turkey An exhibition entitled 'Medicine and Nursing in Britain and Turkey' has been (Continued on page 14)

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the potent new antibacterial specifically for local application NOTE.-' Furacin ' Soluble Dressing is now available in a convenient I-oz. tube. For cost to N.H.S., please see M &. J list of costs dated October 1953

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FIRST AID & NURSING, MARCH/APRIL 1954

Beaders~

Queries Answered by Dr. A. D. Belilios SjSgt. J. M. (Montreal) writes :In treatment of nose bleed, why is ice applied to the spine in line wUh the collar, and why is the patient instructed to breathe through the mouth? In Epilepsy when there are convulsions is it always necessary to place some hard object between the teeth? I am glad to say our Division, The Lt.-Col. Herbert Molson Ambulance Div. No. 50 have won for the 8th consecutive time the George Wright Shield, emblematic of the most efficient Brigade in Canada, and most of our men and much of their interest is founded on reading the overseas First Aid. Answer Greetings to another Canadian reader and congratulations on your achievement.

The patient is instructed to breathe through his mouth to prevent disturbing blood clots in the nose if he breathed through this organ. I have very little faith jn applying ice to the spine and have never done it to any patient myself. In regard to Epilepsy, I would always adopt this treatment. J. R. S. (Weston-super-Mare) writes: In general examinations and competition tests, should questions be confined to the adult course contained in Chapters I to XV of the Manual? I maintain that all questions should be confined to the adult course, without any references to the appendices. Answer According to page 3 of the S.J.A.A. First Aid Manual, the Appendices are not included in the syllabus of the first aid course, and

I personally would not expect a student to know them in a general examination, except in so far as they relate directly to the syllabus. Roller bandaging, for example, strictly speaking belongs to Elementary Nursing, and the application of the Thomas' Splint to advanced First Aid. But if you want to be a good first-aider, study the valuable appendices on Shock, Artificial Respiration, etc. If an examiner asks you questions outside the strict syllabus, and you know the answers, you will obviously get credit.

Cause of Cramp

W. G. (Stoke-on-Trent) writes :The following is a query which has raised a number of arguments. Your kind help will be much appreciated. Quite often one comes across cases . of cramp in the calf, thigh, or even toe muscles, and it is not uncommon to get this at swimming baths. The only time 'cramp ' is used in the Textbook is in cases of strain. But as a strain is f,'here a muscle is overstretched and in cramp the muscles bunch together and harden, the same treatment may not be correct. Your advice regarding what first aid treatment can be given would be greatly appreciated. Answer

No treatment for ' cramp' is laid down in the book, the treatment given is for strain, and cramp is only described as a symptom. Cramp is a state of painful spasm of muscles and there are many varieties quite apart from the examples you give. Sometimes, for example, people develop excruciating cramp while asleep in bed. A treatment that often succeeds is the application of friction by rubbing the muscle upwards. Incidentally, cramp can have serious consequences, if the attack occurs while the patient is swimming. In such cases the swimmer should try and turn on his back and keep himself afloat until the attack has passed. Those liable to recurrent cramp should seek medical advice.

F. M. W. (Hammersmith) writes :Would you be kind enough to give us your opinion on how to treat a patient suffering from a single frac ture of the right clavicle and a compound fracture of the right humerus?

FIRST AID & NURSING, MARCH/APRIL 1954

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Your question has so many implications that it would almost take an article to cover it since principles of first aid such as the treatment of shock, the position of the patient and steady support of the injured limb all have to be considered. First priorities are stopping the bleeding and treating the wound. The fractured humerus should be treated by general methods when the elbow cannot be bent. So far as the clavicle is concerned, treatment can be omitted although the first-aider could place a small pad under the shoulders when the patient is on the stretcher.

C. M. B. (Harrow) writes :I should be grateful for your opinion as to what treatment I should have adopted when a child of three, very scantily clad, fell off a three foot wall into a bed of stinging nettles. There were no physical injuries that I could see so I took her home and advised bed and the doctor. Answer

I think your treatment was admirable but with an accident of this kind, advice re shock should be given. If facilities were readily available, the warm bath with bicarbonate of soda as for severe burns in children might be advantageous as a preliminary. *

A. B. (Oldham) writes :Will you please give your judgment on this question? Some of our members say when single-handed in the treatment of a double fracture of the legs, treat it as per book, that is, one splint, others say three splints. Answer

By double fracture, I presume you mean fracture of both legs (p. 149, S.J.A.B. manual). In this event, I agree with the book. It is difficult to use three splints when you are single-handed. But, nowadays, don't forget we are all entitled to our opinions, or rather good judgment. Never forget the last paragraph on page L7.

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FIRST AID & NURSING, MARCH/APRIL 1954

14 NURSING NOTES (continued) arranged by the Turko-British Association of Ankara. It was opened in Ankara by the Turkish Minister of Health, Dr. Ekrem Hayri Ustiindag, in th~ presence of the British Ambassador, SII Jarn~. Bo~ker. The large audience included dlstmguIShed nurses from many countries. Civilian Relief in Korea For some time past, two British Red Cross sisters (Miss Deadman and Miss Jord~n), have been working in the Seoul Hosp~tal, which has 200 beds and a large out-patient department. It s~ffered. co~sidf?rable darnage during hostilitIes and IS still without many basic necessities. There were not enough mattresses to go round and patients were lying on the bare. sprin~s of the beds. Children sleep on Improvised straw mattresses. In a women's ward of 60 beds there were only four drinking cups an~ three washing basins and not enough linen to allow even one sheet for each patient. Refugees pouring int? the. city .w~re greatly increasing the. difficulties ?~ glVlng civilian relief. Immediately the Bntlsh Red Cross received a report on these conditions it cabled £200 for the purchase of urgent requirements, and authorized the transfer of surplus prisoner-of-war food parcels and

* First-Aider~s Crossmord No. 10

The girl, in a way gives an acceptable present for the smoker 8. Work together to carry out a surgical procedure mainly ... 9. Pages turn to describe incised wound 10. Immediate complication in all serious injuries 11. Breathing and pulse in early stages of asphyzia ... 12. Do this for shock in all cases ... 15. Often most serious when concealed 19. First aid essential. It could well be a ' ninth' point ... 23. Germ of plant, becomes seed 24. Palatal appendage 27. Determines susceptibility to diphtheria 28. Once a mixed water 29. Important beginning in roller bandaging 30. An improvement results when it is turned over

Defence at Brighton. It is the aim of the Union ultimately wherever first aid is taught there shall be trained casualties to assist.

(continued from page 9)

New Study Circles New Study Circles for the training of , casualties' have been formed at Dunkeld, Ireland, at Southampton Docks, by St. Andrew at Ayr, at Blackpool, by H. M. Custom House CD., by the Ministry of Agriculture and Fisheries CD., by Civil

Miss Jordan In Seoul hospital

Casualties Union

Competitions It has been a very busy period up and down the country and the Union has assisted with competitions for the National Coal Board, Imperial Chemical Industries, Electricity Boards, st. John, Red Cross, British Railways, Police and Boy Scouts Association. Two circles in Lancashire at St. Helens and Liverpool have made a splendid contribution with contests for the N.C.B. at Little Hulton, Atherton, Haydock, Prescot, and for the West Lancashire rounds for the Stanley Shields. Congratulations to W. R. Gibson and W. F. Campbell. The Circle at Warrington under the leadership of Miss Elsa Smith is also doing a grand job. The Union was pleased to assist the I.CI. in a number of their divisional contests, including Welwyn, Hertfordshire, Whitton, Birmingham, and Wilton, Redcar, as well as the final round in London.

ACROSS

medical supplies for use in the hospital and for the mobile clinic which has recently been established. The Korean Red Cross is giving all the aid within its power, and the Belgian Red Cross has opened a Baby Clinic. Miss J orden has returned to England for consultations, and for discussion of possible expansion of civilian relief work. Many readers will have heard her broadcast appeal in the • Week's Good Cause' programme on Sunday, 14th February, and are doubtless thinking up ways in which help can be given, especially through their local branches of the Red Cross or of S1. John Ambulance Association. The response of these branches has been splendid ever since the B.R.CS. first appealed for parcels; but the need will be very great for a considerable time yet.

FIRST AID & NURSING, MARCH/APRIL 1954

Regional Contests for Buxton Trophy This year it is proposed to hold Regional Contests to select teams for the final. It is planned to hold eliminating contests in various parts of England, Scotland and Wales simultaneously on Sunday, 11 th July, 1954. Winners and runners-up (depending on the number of eliminating contests) will be eligible to compete in the finaL Regions will be determined by the number of teams entering so as to give all teams an equal chance. The final will be held at Pinewood Film Studios (by kind permission of Messrs. J. Arthur Rank Ltd.) on Sunday, 3rd October, 1954. The actual contest will be on similar lines to the final. Fees for the Regional Contest will be one half guinea only. The fees for teams competing in the final will be the same as in previous years, two guineas so that teams entering the final will be required to pay a further 1t guineas. Entries are inyited from all teams interested in realistic training.

Rules of the Competition may be had by sending a stamped foolscap self-addressed envelope to Miss E. E. Johnson, 8, Woodcote Park Avenue, Purley, Surrey. The closing date for entries is Monday, 5th April, 1954.

First-Aiders in Industry (cont. from page 1)

(4) Factories and workshops having more than ten but less than fifty employees and supplying a first aid box, but where the person in charge of the box need not be trained in first aid. In the large industrial organizations there will be a properly equipped ambulance room or surgery, a rest room, a waiting room, and offices for the doctor and the sister-incharge. Factories in certain classes which employ upward of 500 persons are legally required to provide an ambulance room and, to quote the special Order regarding this, 'The Ambulance Room shall be placed under the charge of a qualified nurse or other person trained in first aid, who shall always be readily available during working hours, and shall keep a record of all cases of accident or sickness treated in the room. ' Although it is not necessary to have a supply of first aid boxes or cupboards where an ambulance room is provided, it is desirable that these should be retained in certain industries ; particularly when the ambulance room is situated at a considerable distance from some parts of the works, for the immediate application of a first aid dressing reduces the risk of infection and lessens pain, especially in burns and scalds. Having now considered the important aspects of the legal requirements and the types of service provided in various industries, the subject of the next, and concluding, article will be the scope and organization of the work itself. (To be continued)

DOWN Drug and plant found in bacon I (7) test 2. They frequently hinder a (7) (7) patient's recovery ... . .. 3. Below is mainly an exhortation (9) (7) to good bandaging, it appears 4. They may be blanket, hot, or (5) (5) medicated 5. Physician of old- named after (5) his worm (5,5) (4,4) 6. The chief pain ? 7. Devoted by many of uS to first (5) (8) aid and nursing (5) 13. Begin morning and end later to (5) improve (11) (4) 14. Curved forms of scar ... (4) 16. Suffers from disease 17. Is described as 'a narrow (11) curved rod about the thick(5) (8) ness of a finger' (5) 18. Friend begins and everyone (4,4) ends avenue in 22 (6,4) 20. The pelvis provides them for (7) the hip joints (5) 2l. This bone almost makes one (7) laugh (5, 4) 22. Busy area for first-aiders during (4,3) London's great events (5) (3,4) 25. Ridicule ... (5) 26. They will not tell a true story (Solution next issue) 1.

SOLUTION TO CROSSWORD No. 9 ACROSS DOWN 1, Lady with the lamp; 9, masseur; to, ], Limping; 2, dashingly; 3, whence; nursery; 11, iliac; 12, excreta; 13, ether; 4, thrush; 5, tender; 6, earache; 7, an 16, gage; 17, dermis; 19, inter; 20, layeye; 8, pay days; 14, thin; 15, extra; 17, men; 22, idea; 24, camps; 27, rubella; drip; 18, medicines; 20, lorries ; 21, 29, cache; 30, inkspot; 31, tetanus; 32, ellipse; 23, asepsis; 24, canthi; 25, sudden illnesses. mental; 26, scathe; 28, baked.

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FIRST AID & NURSING, MARCH/APRIL 1954

Miscellaneous Advertisements Nineteenth Edition. Completely revised. 26/st thousand 286 pp., 286 illustrations, some coloured, 65. 6d., post 4d.

Advertisements with remittance should be sent to First Aid & Nursing, 32 Finsbury Square, Lond"n, E.C.2. Rate 3d. per word, minimum 4s. 6d. Trade Advertisements 4d. per word, minimum 65. Box numbers Is. extra.

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A HANDBOOK OF

ELEMENTARY

ELEMENTARY NURSING

ANATOMY & PHYSIOLOGY

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Arthur D. Belilios, M.B., B.S., D.P.H. ) D. K. Mulvany, M.B.) F.R.C.S., and Katharine F. Armstrong, S.R.N" S.C.M.

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FIRST AID & NURSING, MAY/JUNE 1954

A COURSE IN

ELE~IENTARY

FIRST AID

Wounds and their treatment By A. D. Belilios M.B., B.S. (Lond.), D.P.H. (Eng.)

care of wounds is very T HEimportant in first aid since these are common accidents; they may lead to unpleasant complications whether they be major or minor. Indeed sometimes a small wound is of greater danger than one that is larger since its treatment may be neglected by the patient or the first-aider who may think that it is of little consequence. A larger and often ugly looking wound, however, comes quickly under medical care hence every precaution is taken to prevent complications. Strictly speaking, the term , wound' means any injury which involves a break in the surface of any part of the body. Thus a lung may be injured by a complicated fracture of the ribs, or the spleen may be torn by a blow on the abdomen. In first aid, however, it is usual to consider wounds as those which primarily affect the skin, although they may extend to any depth, through the fat and muscles, down as far as the bone.

It is useful to use the term' minor wound' and to apply it to small cuts, scratches and even pricks which are so common in daily life and which are often treated casually. A' major wound' then becomes any variety which causes the patient or firstaider '. to sit up and take notice.' Various kinds of wounds are usually described as follows :1. An incised wound is like a cut. Its edges are sharp and well-defined although sometimes they are swollen through bruising. It is not always caused by a cut with a sharp instrument such as a knife, chisel, sharp-edged tin, etc.; it may also be caused by a blow with a blunt instrument received on tightlystretched skin, e.g., the scalp. The disadvantage of an incised wound is that it often bleeds profusely because the bloodvessels injured are clean cut. But tbe

bleeding is generally easy to stop and, given proper treatment, the wound heals up quickly, leaving a not unpleasant scar. 2. A lacerated wound occurs when the skin is torn irregularly ; indeed sometimes a piece of skin is torn off the body completely. It is usually caused by a blow with a blunt instrument, by machinery or by a fall on to a rough or jagged surface. War wounds are generally of this type. Strangely enough, this kind of wound is often not accompanied by severe bleeding because the bloodvessels have been twisted in such a way that they are sealed. Indeed there are examples where a limb has been completely torn off the body yet the bleeding has been unexpectedly slight. A lacerated wound, however, has marked disadvantages; it is very liable to sepsis (inflammation caused by germs) and it heals up slowly leaving an unpleasant scar. So far as healing is concerned, a healthy incised wound knits across, the edges being temporarily held together by clotted blood. This method of healing is called first intention but can only occur satisfactorily if the edges are close together. A lacerated or septic wound heals by a slower process called granulation. Clusters of new cells of a raspberry colour appear in the depths of the wound and gradually grow up to the surface, running into each other in the process. When they have reached the surface, new cells grow across from the skin edges and complete healing. 3. A contused wound is one which is accompanied by bruising, the technical term for which is contusion. This means that bleeding has occurred under the skin through the rupture of small bloodvessels. The blood which clots is gradually absorbed, the bruise passing through

the well-known colours of the 'rainbow as this takes place. 4. A punctured wound is usually caused by a sharp instrument such as a skewer which penetrates the skin to any depth. There may be only a small wound of entry but under the skin more extensive damage may be present because the point of the instrument may be moved about thus 'ploughing up' the tissues. Dog' bites are often of this kind and may be very dangerous since imprisoned dirt and germs cannot be removed by first aid methods, hence septic complications are common. Punctured wounds may easily be missed by the first-aider because the wound of entry may be so small. This shows the importance of taking the history of the accident which soon reveals the possibility of the wound being of the punctured type. All injuries of this kind must be referred without delay to a doctor. S. Mixed wounds are very common. Thus an incised or lacerated wound is often also contused while a punctured wound may be accompanied by bruising if bleeding has occurred under the skin.

Complications and Dangers of Wounds Most wounds are liable to complications and dangers. Bleeding and shock are known to every reader while sepsis has already been mentioned. The latter, caused by contamination . with germs which grow rapidly, may cause the wound to discbarge pus (matter) and considerably delay healing. If the germs find their way into the blood-stream, they cause blood poisoning (septicaemia) which may be fatal but in any case a septic wound often causes toxaemia to a greater of lesser degree. This means that the poisons (toxins) manufactured by the germs enter the circulation producing illness of a degree which varies from

FIRST AID & NURSING, MAY/JUNE 1954

, feeling under the weather' to one which is accompanied by fever and all the symptoms that go with it. A serious risk is infection with lock-jaw (tetanus) germs. It is liable to occur if the wound has been contaminated with any form of dirt particularly that containing manure from horses and dogs. Hence doctors frequently give preventative injections of anti-tetanic serum especially in the case of the deeper wounds which air cannot freely ventilate. Tetanus germs grow most profusely in the absence of air hence the danger of this disease in punctured and deep wounds. Other complications include cut tendons, fractures and foreign bodies within the wound such as glass, pieces of torn ' clothing, etc. The possibility of these must be considered when examining any wound while, once again, the history of the accident may give a valuable clue.

Treatment of Wounds The amount of treatment given by a first-aider for a wound depends on (a) the type of wound (b) the facilities that are available and (c) the availability of medical services, i.e., doctor or hospital. In any event, the firstaider should remember that strictly speaking his duty is confined to the immediate care of the patient and is intended to cover the interval that elapses between the occurrence of the accident and the earliest possi ble chance of transferring the case to a medical man. (a) Type of IVound.-All wounds which will ultimately require medical attention should be treated by quick and temporary methods; elaborate forms of treatment should be avoided. Such wounds include those of the punctured type, those which require stitching and those accompanied by complications. The only varieties for which the firstaider would be entitled to do more than pure first aid are those for which an average patient would not normally seek medical advice, e.g., the slight cuts, scratches, etc. Discretion and judgment in selecting cases are more important and if there is the slightest doubt in any case only pure first aid should be undertaken. (b) Facilities.-These, of course, influence the scope of treatment. If the first-aider has the advantage of working in a well-equipped first aid

room of a factory, etc., or in the home, he can obviously give more treatment than if he is called upon to perform first aid in the street or countryside. But there is no object in him doing so if medical facilities can readily be obtained. (c) A vailability of medical ser vices. If it is unlikely that medical facilities will become available for some hours or, in certain cases, days, the first-aider may have to give fuller treatment. In this event, he must be well-trained and experienced firstaider. The Temporary Method To economize space, this will be considered in stages as follows :1. If bleeding is severe, have the patient lying down, elevate and support the bleeding part (except in a fracture) and stop the bleeding by methods which will be described in the next article. If the bleeding is only slight, arrange the patient in a comfortable and convenient position. 2. Expose and examine the wound, being careful not to toucb it. 3. Clean your own hands thoroughly by scrub bing them with soap and water. If tbis is impossible, mop over your hands carefully with cotton wool soaked in an antiseptic such as surgical spirit. 4. Do not disturb the wound unless a foreign body such as a piece of glass is seen lying lightly in the wound in which case mop it away with cotton wool soaked in antiseptic. Make no attempt to remove imbedded foreign bodies and avoid disturbing clots of blood. S. Dab the wound and then the skin around with a mop of wool soaked in surgical spirit or other antiseptic or apply an antiseptic cream. '6. Dress the wound and bandage it. If the wound is of the incised type, arrange the limb before bandaging in a position that brings the edges as close together as possible. 7. Support the injured part, e.g., in a sling. If the wound is big, do not hesitate to apply a splint to ensure rest and support. Obviously the splint should not be applied over the wound itself. 8. Do not forget to treat the patient himself, according to the general principles of first aid. Shock for example, requires attention while the first-aider's manner-calm, confident, cheerful and encouraging, is always of importance.

9. Dress;'1gs.-Whenever possible use prepared sterilized dressings such as the first field dressing, standard dressings N.H.S. or mine dressings for big wounds. Be careful when opening the packages not to touch that part of the dressing which will be covering the wound. If prepared dressings are not available, use several thicknesses of gauze or lint to cover the wound, over which place a pad of cotton wool before bandaging. The Routine Method This refers to the fuller method of treatment mentioned above. It includes cleansing the wound by bathing it with a suitable antiseptic lotion, a step which many authorities do not consider to be ' pure' first aid. Bathing however, is most desirable in many of the minor wounds, i.e., those which medical attention is not obtained. The routine method belongs rather to the realm of the casualty department of a hospital, factory, etc., than to true first aid and since, if it is to be undertaken at all, it must be done thoroughly ; it will not be described further in this article. Div. Supt. A. C. Brown Divisional Superintendent A. C. Brown, 119 (Epsom and Ewell) Ambulance Division, S.J.A.B., who died on 10 January this year, had 41 years service with the Brigade. He enrolled in the Wandsworth Division in 1913 and formed the 149 (Worcester Park and Stoneleigh) Division 15 years later. At the amalgamation of the Epsom and the Stoneleigh Divisions, Mr. Brown took the helm and steered the Division through the difficult post-war years culminating in the fulfilment of his greatest ambition when his Division obtained their own ambulance as recently as last September. The Brigade and 119 Ambulance Division in particular have suffered a severe loss with the death of such a devoted and respected officer. Institute of Certified Ambulance Personnel The following were successful in . the Preliminary Examination of the Institute held in Burnley on 27th April, 1954 : J. A. Bailey, Colne, Lanes ; J . P. Barl?w, Heywood, Lanes; A. Berry, Prestwich, Lanes; H. Bottomley, Colne, Lanes; G. Daly, Walkden, Manchester; R. J. Fairlamb, Hythe, Kent; J. 9aw, Worsley, Lanes; E. W. George, Skipton, Yorks; F. W. Goodchild, Burnley, Lanes; Mrs. G. Hillary, Nelson, Lanes ; A. Howley, Colne, Lanes; S. Pickup, Colne, Lanes; Mrs. M. Sharp, Burnley, Lanes; J. Tomlinson, Nelson, Lanes; R. Th?rnton, Burnley, Lanes; Miss F. J. Whittaker, Cowling, Yorks. Miss Whittaker gained 1st plaee an~ Mr. FairJamb gained 2nd place, 10 the lIst of candidates.

FIRST AID & NU R SING, MAY/JUNE 1954

Notes on advanced physiology By F. C. Reeve F.Z.S., F.R.E.S. BEFORE passing on to discuss the next system I propose to add a short corollary to my last article on the heart and circulation, but I have a definite reason for doing so. At the Borough Polytechnic on 23rd April, on the occasion of the B.T.e. Southern Regional Competitions I overheard a number of competitors discussing the circulation of the blood, and it appeared that they were somewhat puzzled over certain terms often used to describe various conditions of the pulse, and particularly the apparent differentiation of , rapid and feeble' and ' quick and weak.' Another term that puzzled them was' thready.' Joining in the conversation I promised that I would endeavour to explain these points in our next issue. A comparison of the works of various writers on insensibility discloses a tendency to describe the condition of the pulse in shock as 'rapid and feeble,' whereas that observed in cerebral concussion is usually described as 'quick and weak.' Let me admit right away that any possible difference in the respective conditions of the pulse is academic rather than real, so perhaps my best plan would be to describe as briefly as possible what is believed to be the cause of each of these conditions. For many years shock was regarded by surgeons as somewhat of a mystery condition, but it is now generally accepted that it is closely associated with loss of blood volume, either on to the surface, into one of the body cavities or by absorption into the tissues, and this type of shock, which is known as ' oligaemic,' forms the great bulk of such cases. It will be obvious that any considerable loss of blood from the system must affect the venous flow before the arterial, as less blood will be returned via the venae cavae to the right auricle. This means that less blood will pass through the four chambers and emptied (after, of course, passing ~hrough the lungs for purification) mto the aorta. Now it is a bio-

logical law that, whenever some disturbance takes place in the working of this living machine, nature makes strenuous attempts to compensate in one way or another for the upset, and in this case, in order to compensate for the disturbance caused by the lowered volume of blood in the whole system the contractions of the heart are increased in number. Further, it will be obvious that if a smaller quantity of blood is being pumped through the vascular system at a faster rate, the pressure against the walls of the blood vessels will, also, be reduced, or, in other words, the 'tension' will be less. Now let us see what takes place in the case of cerebral concussion. If you read my last article in the March/April number you will recall that I explained that the beating of the heart is the result of a nervous stimulus which has its origin in the heart muscle itself and is not controlled by nerves direct from the brain centre. At the same time the rate at which the heart beats is controlled from the brain, for the vagus, or tenth cerebral nerve, acts as a break and prevents it from beating at more than a certain rate. When the head receives a blow, this nerve, although it may not be actually damaged, will probably be temporarily paralysed, suspending its braking power and allowing the heart to beat at a faster rate. As soon as the vagus recovers from the effects of its shaking it resumes its function of a brake and the heart beating returns to its normal rate. I have attempted to present simply and in as few words as possible, what is really a most intricate subject to which many chapters should be devoted in order to explain it thoroughly, but I trust that it will be realized from what I have written that for all practical purposes the first-aider need not trouble about this apparent contradiction in terms. No examiner or judge would expect you to make so fine a distinction.

Whether you describe the condition of the pulse in shock or concussion as ' rapid and feeble' or ' quick and weak' will not matter, for either description will show clearly that you yourself in examining a patient have perceived the nature of the pulse abnormality. When the volume of blood passing through the radial artery is so reduced as to make the vessel easily compressible it is called 'thready.' It is associated with a very perceptible increase in pulse-rate. Respiration, Natural and Artificial By the time this issue is in the hands of its readers the holiday season will be in full swing. All around our coasts St. John and Red Cross men and nurses will be staffing first aid posts, prepared to render assistance to all those unfortunate beings in need of help. Cut feet, abrasions, sprained ankles, sunburn, indigestion, nausea and vomiting, sore tummies, fish-hooks, etc., will all be taken in the stride ... and the partially drowned. Yes, far more of the 3,000 drowning tragedies which are reported annually could be averted if more people knew exactly how to deal with the partially drowned. This, however, is a specialized task, and a thorough knowledge of the mechanism of natural respiration, and an intelligent appreciation of what you must try to imitate in performing artificial respiration will enable you to undertake resuscitation with far greater confidence than if performed merely as a drill. For this reason I have decided to write upon this subject at this season. Suppose we commence with an experiment. Take a Winchester jar and replace the glass stopper by a cork. Through this cork bore two holes, passing through each a glass tube about 3 or 4 mm. in diameter. One should project above the cork, say, 2 in., and the other about 6 in. , the latter being bent slightly from the perpendicular for convenience. Both

FIRST AID & NURSING, MAY /JUNE 1954

tubes should project into the jar about 2 in. To the bottom of the shorter tube fasten securely a small child's bladder, such as can be purchased at any toyshop for a few coppers, and you are ready for your experiment. You will remember learning during your science lessons at school that the atmosphere exerts a unifonn pressure on the surface of everything around you of 15 lb. to every square inch. If this is so, why do we not collapse with so great a pressure on our surfaces? Why does not the table subside under so great a weight? It is because the same pressure is exerted inside as well as outside, underneath as well as on top, thus maintaining an even balance of pressure. Now look at the indiarubber bladder inside your jar. Were it made of paper, linen or practically any other material, it might be expanded or it might be collapsed, because this atmospheric pressure would be exerted both inside and outside the bag. As in this case the bag is made of rubber, an elastic substance which contracts we see that it is in a collapsed condition. Now put your mouth to the top of the longer glass tube which we slightly bent for the pur~ pose, and draw just a small quantity of air from the jar, closing the end with your finger before withdrawing your mouth. The bladder immediately becomes inflated. This is because, by withdrawing some of the air from the jar, we have created a partial vacuum, or, to use the scient~c term, we have set up a negatIve pressure, i.e., less than 15 lb. to the square inch. Now the pressure inside the bladder still re:r;nains at 15lb. per square inch, and bemg now greater than the pressure outside the walls of the bladder are naturally pushed out. A similar negative pressure inside the jar could be produced if it were possible by some means to enlarge its capacity, because the same quantity of air would be occupying a larger space. In order to do so it would become , attenuated' or spread out. Having grasped the principle in~olv~d in this experiment try to Imagme the bladder with its glass t~be to be of microscopic proportlons, composed of human body tissue instead of rubber and glass and merely one of a vast number ror~ng a dense mass. If you can Imagtne this you will have a very

clear idea of the composition of the lungs . This mass of tubes and aircells,. however, are arranged upon a defimte plan. They are the terminal branches of the bronchi, which divide and sub-divide like the branches twigs, stems and lea es of a tree. We will leave for the time beinG the subject of the structure of th~ lungs. and study the air which they contam. There appear to exist a popular belief that fresh air consists almost entirely, if not entirely, of oxygen, or, in other words, that fresh air and oxygen are synonymous terms. As a matter of fact atmospheric air contains only 20 p.c. of oxygen the remaining 80 p.c. being almost entirely nitrogen. I say , al~ost' for these figures are approXlmate, allowance being made for some tiny percentages of some other ingredients which, for our present purpose, are of less importance. There is, however, one exception, that is carbon dioxide, which is of very great importance, but more of that later. Although oxygen does not form a. large proportion of atmospheric aIr, contrary to popular belief it is at the same time, of vital importance, for without it we could not breathe. Pure oxygen, however. is irrespirable, and in order that it may be breathed it must be diluted, and it is the nitrogen in the air which dilutes it. The ratios are, therefore, 4 parts of nitrogen to 1 part of oxygen. (To be continued)

Tickets of admission can be obtained price 2 6, from Miss E. E. Johnson, 8 Wo~dcote Park Avenue, Pudey, Surrey. Applicants are requested to enclose an addressed envelope for reply. Stanley Shield Members of Casualties Union were highly complimented by H.R.H. The Princess Royal on their perfomlance as casualties for the team tests in the Trial Rounds for the mens' and womens' Stanley Shields at Friends House on 22nd May.

N.A.T.O. Wing-Cmdr. Sir John Hodsoll, VicePresident of Casualties Union has been appointed Civil Defence Adviser to the North Atlantic Treaty Organizatio n. It is understood that Maj. Gen. S. F. Irwin is to succeed him at the Home Office.

CASUALTIES UNION Bu."don Tropby 96 tea.l1?-s have ent~red f,?r this year·s open Comp.etltlOn on DiagnOSIs and First Aid orgamzed by Casualties Union. This compares with 35 teams last year, all of whom comp~ted at Royal Air Force, Hendon, in the Fillal Round. This year it has become necessary to hold eliminating rounds which are to be held in t\vel\'e regions. In the South-west a contest is to be held on Sunday afternoon, 4th July at the County School for Girls, Treye~v Road, Truro at 2 p.m. Other eliminating rounds will be held on Sunday afternoon, 11 th July. at 2 p.m. in the following places: Weeke Manor Stockbridge Road. \ inchester: Brock Barracks Playing Fields Oxford Road Reading, Berks: Beau~ont School, St: AI.bans, Herts : Stroud Technical School for GIrls, pownfield,. Stroud, Glos. : Imperial Chemical Industnes', Kynoch Works Sports Gro~d, Perry Barr, Birmingham, 6; Altnncham Association Football Ground Moss Lane, Altrincham, Cheshire· Dar~ lington Railway Athletic ssociation'Rugby ~ootball Ground, Brinkburn Road, DarImgton: The Royal Grammar School Newcastle-upon-Tyne. ' . There will also be contests on 11 th July Surrey, London and Norwich. Details of these contests can be obtained from the Regional Competition Secretaries' whose addresses are: John Wade. 107, Kilmartin Av., Norbury, S.W.16; R . R. H. Humphreys, 5 Clarevale Road, Hendon, Middx. ; Mrs. G. Payne, 53 Whitehall Road Norwich. '

As there is only one team in the Scottish Region, .no elimin~ting contest is required. Impenal Chemical Industries, Nobel Division of Glasgow, go straight to the Final. There are no tickets for admi sion to the eliminating conte ts, but spectators will be welcomed at each of the Regional Contests. Teams of six compete. Four of these undertake a team test by clearing up an , accident' and the remaining two members each handle and diagnose the condition of a series of patients . All the patients will be trained members of Casualties Union drawn from Branche and Study Circles at the respective regi ons. The contest indicates the type of assistance that Casualties Union offers to First Aid and Civil Defence unitspractice in diagnosis where typical case can be compared and contrasted during training sessions- practice in handling and the application of treatment observing throughout the effect on the patient who ha been trained to respond appropriately- practice in dealing with accident situations. The Final Contest will be held at Pinewood Film Studios, rver Heath, Bucks, on Sunday, 3rd October, 1954, at 2 p.m.

(continued 011 preceding colullIn)

FIRST AID & NUR SING, MAY/JUNE 1954

FIR ST AID & NURSING, MAY/JUNE 1954

CO.JIPET1TIOA.V S BRiTISH RAILW AYS & TRANSPORT POLICE

ST ANLEY SHIELD 21st May, was a busy day at F RIDAY the Central Hall, Westminster, when the British Railways and London Transp?rt (Railways) and· British !ranspo~t Poli~e held their Annual atlOnal FiTSt AId Competitions under the auspices of the St. John Ardbulance Association, for five valuable trophies. Twenty-six teams, men and women had entered for these contests, and at any' time during the whole day six events could have been seen taking place simultaneously in various rooms. The men's team had to treat a man who had fallen from a ladder and was suffering from a fractured lumbar spine with damage to cord a wound on the forehead with profuse bleeding, a simple fracture of t~e right clavicle concussion and shock. Little first aid material was available, but some , nappies ' were seen on the clothes line and the daughter was able to provide some old rags. The members of the women's team were riding in a 'bus and had to treat a passenger who fell down the 'bus stairs head foremost. The first difficulty was to remove him from this awkward position. He was then found to have fractured his left tibia and fibula, his right radius and ulna and to have sustained a wound on the nose. Here again little material was available. Numbers 1 and 4 of the men's teams, for their dual practical test, found a man lying over a crate of broken bottles with an incised wound on the right cheek and a piece of broken glass firmly embedded in it and a fracture of the right clavicle, whilst their colleagues, Numbers 2 and 3 discovered a man who had evidently fallen downstairs. Correct examination revealed fractures of the 5th and 6th right ribs and fracture of the right femur. umbers 1 and 4 of the women's teams also had a 'bus accident to deal with. As a result of the 'bus skidding into a wall a passenger, still in his seat, was found to have a wound of the left cheek and a compound fracture of the right patella. Owing to the confined space in the 'bus competitors were expected to remove the patient and treat him lying on the ground. In another room we found the setting of a railway platform with a train just arriving. A compartment door opens and a man jumps out, slips and falls forward catching both feet between the running board and the edge of the platform. Numbers 2 and 3 are on the platform and are called upon to treat an incised wound on the right shin with slight bleeding, contused abrasions on both calves and a simple fracture of the right clavicle. First aid equipment can be

[xmoutb Junction team receive the shield.

found in the station master's office. Truly a mixed grill of accidents and injuries ! Soon after 4 o'clock spectators and competitors assembled in the large hall to hear the results and to witness the presentation ceremony. The chair was occupied by Mr. Horace F. Parshall , T.D., M.A.Oxon., Director-General of the St. John Ambulance Association, and he was supported by General Sir Brian Robertson, Bt., G.C.B., G.B.E., K.C.M.G., K.C.V.O., D.S.O., M.C., Chairman of the British Transport Commission, who had kindly consented to present the trophies, Col. E. Croft, Deputy Director-General, and the judges. In opening the proceedings Mr. Parshall said that it gave him much pleasure to welcome Sir Brian Robertson, whose great interest in the movement was symbolic of that displayed throughout the B.T.e. He also extended a cordial welcome to all the other visitors there that day, including many members of the st. John Ambulance Brigade. Their thanks were due to all those who had assisted, especially to the Associated British Picture Corporation Ltd. for their continued generosity in supplying and erecting the stage settings which provided so colourful and dramatic a background to the scenes, an enormous contribution to the success of the whole event. There were again, also, deeply indebted to the judges who so generously gave their time and skill in helping to promote this great work, and he specially mentioned Dr. George who bad kindly stepped into the breach, at a moment's notice, caused by the unavoidable absence of Dr. Cubitt. The judges were: M. C. Cooper, M.e., M.R.C.S., L.R.C.P., of Looe (Men's team test); K. S. Maurice-Smith, M.R.C.S., L.R.C.P., of Ely (Railway women's and B.T.C. team test); S. E. Jackson, M.B., Ch.B., of Scarborough, J. S. Hamilton, M.B., Ch.B., of Burslem (Men's dual practical tests); Dr. W. George, of Lancaster (deputizing for Dr. Cubitt); and J. E. Baker, M.R.e.S., L.R.C.P., of Sheffield (Railway women's and B.T.C. Police dual practical tests). Tribute was paid to the work of Mr. George E. Craft, Competition Secretary, whose untiring efforts were largely responsible for the success of the gathering. The Chairman also thanked the stewards, patients and all who had contributed to

make the competitions a success. The comments of the judges are always valued by the competitors, and in response to the Chairman's invitation, Dr. Cooper commented upon the men's team test which he had judged. 'You will expect me to address my remarks principally to the teams,' he said, adding that there was not much to criticize, although teams were sometimes inclined to overlook details, which were, after all, important. At the same time essentials must come first, and in the case of his test the spinal injury should have been given priority over all other injuries. The moving of a spinal case was always a dangerous procedure, and he congratulated those teams which had exercised the greatest care. Unfortunately some of the teams had not diagnosed the spinal injury early enough, but, on the whole, it had been a good piece of work. He was followed by Dr. Maurice-Smith who opened his remarks by saying' T have often wondered what happened to people who fell downstairs. ow I know,' he added, amidst laughter. He emphasized the importance of identifying the injury correctly before attempting to move the patient, and especially of securing fractures to prevent further movement. As to the realistic manner in which the' patient' had fallen downstairs eleven times, he could not pay too high a tribute. Speaking for Dr. Baker at his request, he emphasized the importance of observation. 'Take notice of the surroundings,' he said 'for many things are placed there on purpose for you to notice.' D r. George pointed out that it was not safe to rely entirely upon the condition of the clothing in diagnosing haemorrhage, for damp clothing did not always accompany it. Haemorrhage must be sought for, especially in the dark. The results were then announced as follows : Men Mark s 1. Exmouth Junction 504 (wirIniog the Challenge Shield for the second year in succession). 2. King's Cross 490 (winning the Corbet Fletcher Cup). 3. Derby Erecting Shop ... 479 4. Camden Goods 452k 5. Shrewsbury Loco. 'A' ... 443 6. Swindon 'A' 442 7. Motherwell 424

Exeter B.T.C. Police team, winners of tbe Transport Police Competition.

8. 9. 10. 11. 12. 13.

Bridgeton Hull Dairycoates Newcastle Central Lots Road Brighton o. Yarmouth

413 379~

361 357-!357312t

Women Marks 1. Glasgow . . . . . . . . . 485 (winning the Burrows Rose Bowl). 2. Horwich... 443 ~ 3. Marylebone 433} 4. Hull D.O.S. 4185. Broadway 415 6. B.T.e.P. ... 412~ 7. Newton Abbot 384-

B.T.C. Police Marks 1. Exeter 458 ~ (winning the Sir Bertram Ford Challenge Shield). 2. Darlington ... .. . . . . 426 (winning the Chief of Police Cup). 3. E~inburgh ... ... ... 423 i 4. Wlgan o. I ... 423 5. Bricklayers Arms 413i 6. Parkes tone Quay 380Maximum marks possible 600. In accepting the invitation of the Chairman to present the trophies, General Sir Brian Robertson said that it was a great honour, and it gave him real pleasure to hand these magnificent prizes to the winners. 'We are indebted to the St. John Ambulance Association for so much,' he continue~ .. There was, undoubtedly, grow109 enthisiasm amongst both the railway m~~ and women and the police of the Bntlsh Transport Commission, and this was reAected in the fact that last year 21,000 students underwent training in this valuable art. In the B.T.c. first aid was a tradition and in an organization in which a certa~ number of operations could conceivably Jead to accidents its importance could not be over-estimated. The figures he had quoted shook him when he first heard them. Doing the same thing over and over again could become mechanical and could therefore, lead to accidents a fact whicl~ was impressed upon him wh~n he was with

his men in the Army. Many accidents had been due to the carelessness with which troops sometimes handled their arms. , What was the secret of their success in ambulance work in the B.T.e. ?' he asked. He believed it was due to the great spirit of camaraderie which existed amongst them. Since he had been with them he had found them a magnificent crowd of fellows with whom to work. In presenting the first trophy he caused considerable laughter when he said' These fellows from Exmouth seem to make a habit of it! (Exmouth Junction also won it last year.) He was also pleased to see the lassies from Glasgow. Mr. Parshall's sincere expression of thanks to Sir Brian Robertson brought to a close a most interesting series of events.

BRlTISH RED CROSS SOCIETY'S FINALS for the ST Al\'LEY SlllELDS and other trophies. At last the Great Day has come and gone, and the Stanley Shields will go to their new resting places-no, not both of them, for one will return to its home of last year, Kent. The 22nd of May was, however, a memorable day, providing many exciting incidents. An early start was made with

otts men's team during the competition.

Sussex women's team in action.

the inspection of uniforms, and both men and women were, undoubtedly, a credit to the organization. This was followed immediately by the commencement of the tests which were as follows :'''omen Team Test, First Aid, judged by SurgeonCommander, J. L. S. Coulter, D.S.C., R. ., and Wing-Commander W. Davies. Team Test, ursing, judged by Miss J. Addison, S.R. ., Matron of Guy's Hospital, and Miss B. . Fawkes, S.R.N., Principal Sister Tutor, Middlesex Hospital. Indi\ idual Tests, First Aid, judged by Col. W. McKim McCullagh, D.S.O., M.e., T.D., F.R.C.S., Wing Commander L. E. A. Dearberg, R .A.F., and Col. G. M. Frizelle, T.D., M.D. Individual Tests, ursing, judged by Miss D. Holland, S.R. ., Sister Tutor, Guy's Hospital , Miss D. A. Lane, S.R. . , and Miss M . E. Coombe, S.R. ., Assistant Matron of St. Thomas's Hospital Uniform, judged by Mrs. M. E. Kinder, County Director, Bristol Branch, B.R.e.S. , and Miss . Branigan, County Director, Dorset Branch, B.R.C.S. (continued overleaf)

FIRST AID & NURSING, MAY JUNE 1954

COMPETITIONS

From a seat in the audience

(continued from page 7)

Some Random Comments by F. C. R.

Men Team Test, judged by Group Captain J. Parry-Evans, R.A.F., and Lt. Col. W. Windsor, R.A.M.C. Individual Tests, judged by Maj. J. Kilgour, R.A.M.C., and Surgeon Commander T. W. Froggatt, R. . Uniform, judged by Maj. General L. A. Hawes, e.B.E., D.S.O., M.C., Controller, Home Dept., H.Q., B.R.e.S., and A. T. Tunnell, Esq., Divisional President, Surrey Branch, B.R.C.S. In the Women's Team Test the members of the team were called to the flat of Mrs. Mopp and her daughter, both of whom had been engaged in putting up Christmas decorations. The ladder upon which Jane had been standing collapsed, and she had fallen to the ground, knocking over her mother at the same time. Mrs. Mopp had a deep laceration of the left forearm with moderate haemorrhage, a dislocation of the left elbow, joint, severe shock and was dazed. Jane was suffering from compound fractures of left tibia and fibula with moderate haemorrhage a severely cut palm of right hand with moderate haemorrhage and moderate shock. The Men's Team Test also concerned decorations but this time out of doors. A workma'n, in erecting decorations in readiness for a street procession, has turned on the electric current to test the illuminations when he falls, breaking an electric cable. The free ends of the cable electrocute a passer-by. The injuries to be treated are: Workman: Fractured spine (dorsal, with paralysis) and severe shock. Passerby.' Electric shock, electric burn on right side of face, breathing imperceptible. At 2.30 p.m. H.R.H. the Princess Royal, Commandant-in-Chief, arrived and was received by Lord Wool ton, Chairman of the Executive Committee, and Mrs. Anne Bryans, e.B.E. A guard of honour was formed by members of teams not then undergoing their tests. Her Royal Highness then spent two hours watching the teams at work, displaying the greatest interest in the~ activities. At 4.35 p.m. the Judges, Presldents, County Directors and County Secretaries were presented to Her Royal Highness, after which, whilst Her Royal Highness and the officials were at tea, the scenery which had been used for the women's team test was removed and the stage in the Great Hall was transformed in readiness for the Presentation Ceremony. For this the Chair was occupied by Lord Woolton, and he was supported by H.R.H. the Princess Royal, Air Commodore H.A. Hewat, C.B.E., M.B., Medical Adviser, Mrs. Bryans, Maj. Gen. L. A. Hawes, C.B.E., D.S.O., M.e., Controller, Home Dept., Headquarters, B.R.e.S., Miss Hetherington, M.B.E., Staff Office! and the judges. Before calling upon the Judges to give their reports the results of the competitions were announced as follows :-

Railways and B.T.C. Police When will students learn the correct method of palpating for fractures? Covering the patient in treatment of shock must not become a fetish. Study the weather and use discretion. Overheating is just as harmful as neglect of warmth .. Fanning the patient was sometimes nothing but a gesture, lasting only a few seconds. The position for the pad in the hollow of the back when transporting a fractured spine must not be guessed. The pad, is also, sometimes too thick. Although the nose wound of the 'bus passenger was apparently slight it was ju~t as likely to become infected as a more senous one and should have been covered earlier in some cases. After all, there were four trained and one untrained persons available. One women's team tested the stretcher before it was fully opened! Why was the conductor not asked to assist in lifting by some women's teams ? Why did a women's team sit the patient up for examination ? How few remember to check the pulse of a shocked patient after the lapse of a period. After all, it is the RELATIVE reading which provides so much valuable information. Was the patient's condition improving or deteriorating? It is necessary to make a special 'phone call to warn hospital? Casualty is always prepared for an emergency. More stretcher drill OVER OBSTACLES is indicated. Treatment of the fractured patella, especially in so awkward a position, was, on the whole, good, but not all realized that it was compound. Competitors are advised to try taking a drink from a cup or tumbler whilst lying supine. There is a special technique for this. The need for more instruction in regional anatomy (landmarks and surface markings) was demonstrated by some who had no idea of the positions of the 5th and 6th ribs. A hot water bottle is used for its general rather than its local effect. Further, no matter what the circumstances may be it MUST be covered. One patient was assisted to his feet and walked to a blanket spread on the ground before any attempt was made at diagnosis. What a large number of competitors overlooked the supported elbow and inclined head, diagnostic of fractured clavicle. 'Speak encouragingly to the patient,' but don't let this become parrot like. Placing the hands on the stretcher is not , testing' it, and there is a recognized drill for opening it. Stretcher drill was generally weak. One team expected far too much of the housewife, forgetting that she was untrained. The severest stretcher test I witnessed was when the conductor was bumped up and down on it ! Do, please, support the head when using the blanket lift. Patient's choice-' Head or feet first?' How many remembered this ?

Would it not have been preferable to bring the stretcher to the patient instead of carrying him down the bank to the stretcher? It is not necessary to count the pulse aloud. The judge can see what you are doing. What were the feelings of the patient who was offered a cup of tea whilst lying head downwards on the stairs of the 'bus ? B.R.C.S. Finals Why prepare stretcher before examining the patient? Were they quite certain that it would be needed ? In applying artificial respiration how many are able to estimate correctly the length of a second? Test it for yourselves. A two-handed seat is not always the best means of carrying a patient. Study the injuries before deciding. Now, nurses, what about those fracture boards ! Body mechanics and the technique of lifting and carrying patients need more study. In promoting circulation don't forget that the basilic vein passes along the front of the arm and not the back. A pat on the back for the leader of Suss~x 114 for the cool and collected manner III which she directed her team. One nurse casually kicked a piece of broken crockery but did not pick it up. 'Remove the (potential) cause,' says the text-book. Was it necessary to place the bed against the wall, with the result that the patient had to be attended from the left-hand side? Don't hold the thermometer by both ends. Some had obviously acted upon a recent suggestion of mine by attempting a more methodical diagnosis, but do not let this develop into a mere recital of possible symptoms. At least give the patient time to grasp and answer each question. In taking name and address of the patient a record of his occupation may prove of valuable assistance to the casualty officer in his further examination. One pair of nurses should by now be experts in moving beds about. Why not make up your minds in the first place where you want them ? Bed-making was good but would have been better if the movements of each pair of nurses had been synchronized. Several times I saw one nurse at the top and the other at the bottom at the same time. I wonder if it is altogether wise to warn the teams five minutes before the expiration of time? Does it tend to create nervousness? I raise my hat (or I would if I wore one! ) to those nurses who remembered to raise the foot of the bed in cases of shock, but 9 to 12 in. are quite sufficient. What were the indications for raising Mrs. Mopp's legs so high-certainly a most uncomfortable position? How many noticed whether the windows of the bedroom were open or closed? T.P.R., although usually taken, were not always recorded.

Marks 744 (winning the Stanley Shield for Women). Devon-64 .. , ... ... 702~ East Lancashire-98 681

Women 1. Warwickshire--2

2. 3.

FIRST AID & 1'.TURSING, MAY JUNE 1954 4. 5. 6. 7.

Angus-4 London-loo Denbigh-12 Sussex-114 Kent-78

66B 660639 621 607

j\![arks 766 (winning the Stanley Shield for Men). 708 ,~ otts-15 701Sussex-I 3 671 !Roxburgh- 3 Durham-79 628t Wilts-l 9

Men 1. Kent-87

2. 3. 4.

5. 6.

Hetherington Cup for team \vith highest marks for ursing won by Devon-64. Evelyn Wren Cup for woman officer with highest individual marks won by Officer Miss M. I. Berry, M.A. (Hons.) of Devon -64. Georgina E. Morgan Bowl for woman member with highest individual marks won by Miss E. M. P. Gordon, of London-l00. Margaret Gordon Harker CliP for men's team leader with highest individual marks won by Officer A. Killick of Kent-87 and G. H. Slade of Sussex-13 (tied). Lt. Colonel R. M. West CliP for member (men) with highest individual marks won by J. Hall, of Roxburgh-3. Lord Woolton then invited Miss Addison to comment upon the work of the teams which she had judged. Speaking for both herself and her associate judge, Miss Fawkes, she said that it had been a great pleasure for them both to be there that day, for they felt that it was a most stimulating event. Commenting upon the work of the competitors she offered, in a most frank manner, some very severe but valuable criticism. Beds were not properly prepared and were untidy she told her hearers. , Don't put bedding on the floor,' she warned. Everything should be moved out of the way and a clear passage prepared before attempting to move the patient. Always wipe the thermometer, both before

and after use, and never lea\'e it unattended in the patient's mouth, e\'en if vour leader does call you. Surgeon-Commander Coulter followed with further criticisms, this time of the men's team \vork. He, also, was very frank. He regretted that he had to confirm all tbat Miss ddison had said. EYen the winning team was bad and the standard low. Two teams received no marks at all for treatment of shock. He thought that the whole essence of failure lay largely in lack of decisiveness. . Make up your mind what you want and what you intend to do: he advised. When telephoning for the ambulance don't say' Would you mind sending.' You might just as well say . I'm a\\fully sorry to trouble you.' At the same time he was very fair and congratulated the competitor who contradicted him on some point and who eventually proved to be right. Doctors and judges did not always know best, he told his audience and if you disagree with them. tell them so. Dr. Parry-Jones, commenting upon the men's team test. said that, whilst he had found it very interesting, he had the same tale of woe to tell. The work was not up to that of previous years. Both ca ualties " ere urgent in the team test but artifiicial respiration must be commenced without loss of time. However. he observed that the treatment of fractures had ob\'iously been well practised, but details must not be overlooked. Do not forget to look for otber injuries. In transporting a case of fractured spine you must provide a rigid platform on which to carry the patient. Few gave reassurance to the patient, and those who did added it as an afterthought. In performing the new Holger-Nielsen method of artificial respiration there was a tendency to press too hard, and the band was not stretched sufficiently. Hi last hint was , The best leaders produce the best teams. The leaders are there to control, not to treat.' Howeyer, in spite of all his criticisms, he concluded, both patients got to hospital and both were doing well.

H.R.H. Princess Royal~s Speech Her Royal Highness then, in response to Lord Woolton's invitation, graciously presented the trophies to the winners of the various events. She said' As always, I am delighted to be present to-day and to meet so many Officers and Members of the Society. , I would like to congratulate warmly all the teams who have taken part to-day. Whatever the order in which they have been placed, their presence here is a great achievement. '1 want to take this opportunity of streSSing once again my conviction that training in first aid and nursing must be so thorough that action becomes instinctive. In this way we learn to react when conditions are difficLllt-when, perhaps, life is in danger and others are looking to us for leadership. , Now the Stanley Shield is an admirable incentive to training, but this incentive must not be confined to the selected few eyery year. Nor must it monopolise the time of detachments to such an extent that other important activities are neglected.

'I \vant you all next year to organize your training for the Stanley Shield so that the whole detachment benefits. This can be done if the members of your potential teanl are each put in charge of three or four members with whom they practise, and with whom they acquire the art of leadership. Only in the final stage of preparation should the team be set apart. In the preliminary stages, one practice team carries out the test, the remainder look on, having previously heard what should be done and wby. The former learn from making mistakes, the latter learn by seeing them made. , I would like to end on a more urgent note. These are anxious times but they present a challenge to us who belong to the British Red Cross Society. 1 look to you all to set an example of steadfast and unselfish purpose for all to follow.' Thanking Her Royal Highness, Lord Woolton said that all were most grateful to her for coming there that afternoon. The friendliness with which she carne among them was greatly appreciated, and he asked her to accept their most grateful thanks.

9 CO~lPETITIO~S

t thi time of year we re eiye a great many report of fir t aid and nur ing competition. and we much regret that we do not have ufficient pace to publi h them all. If we attempted to do 0 there would be no room for our regular article - nnd feature . ~ To re triet a report of a competition to the placing of the team i not atisfactor\'. and intere-t ' only tho e who took part in the te t. Competition are a ,"aluable feature of fir t aid training. and we feel that much u eful work can be done by fully reporting them in our journal. e pecially if the report is \\ ritten by a competent first aid in tmctor \\ ho can add his O\\'n comment on the te t. But space is limited, and if we publi h full report of one or t\\'o competition then many other mu t pa unnoticed in our olumn. We think that by publi hing full report, with comment, on a fe\\ competitions, we are prO\ iding a more u eful sen'ice than by briefly reporting many competition-. \Ve hope our reader \yjU agree with thi , and we trust that the hard-working secretarie of fir t aid group and teams who send us copy for publication will understand why we cannot always use it, and that they will continue to let u have ne\\' of their activitie. One day we may be able to give it the pace we are sure it deserve. Lady Limerick had sent an apology for ab ence that day, as he \\'a representing the Briti h Red Cross Society at the Conference of the International Red Cro s at 0 10. Lord Woolton thanked the judge, not merely for their work in judging the competition, but for the fearle s manner in which they had offered their criticism. He knew that this would be appreciated by aU those who had listened. He was quite certain that the members would benefit, and next year the work would be all the better for their frankness. He al 0 wi hed to express to the A socia ted Briti h Picture Corporation Ltd. the appreciation of the Society for their genero ity in prm iding and erecting all the stage setting for these Finals. Mrs. Hetherington, who always insist in taying in the background, had been re ponsible for all the arrangement for this most successful event, and he wi hed to convey to her the gratitude of all. The work of the Casualties Union, and Es ex and Middlesex Branches, B.R.C.S .. who had trained and provided the 'patient ' also deserved tbeir most grateful acknowledgments. A most enjoyable day came to an end \\jth the singing of the National Anthem.

FIRST AID & NURSING, MAYjJD E 1954 10

British Railways Eastern Region Probably no organizations take a great~r interest in the ambulance work theIr staffs than British Railw~ys,. and if confirmation of this were reqUlred It would .have been found at the Bishopsgate In~tltute, London, on Wednesday, 7th Apnl last. There seven first aid teams, the cream of the Eastern Region Ambulance Centre, competed for the Eastern Re~ion Bowl aJ?d for the privilege of representm~ .the RegIor: at the Inter-Regional CompetItIOn,. o!ganJzed by the St. John Ambulance AsSocI~tIOn , held later at the Central Hall, Westrrunster, on Friday 21st May. The seven teams were Yarmo'uth Colwick, Liverpool Street, Doncaster Tra'ffic, Tuxford, .King's Lynn 'B' and King's Cross MotIve ,Power, ~ll of whom had survived a gruellIng test m ~he preliminary competitions in their respectIve districts. The tests set for the competitors proved most interesting, and were as follows :-

Team Test: Story,' Two men are seated in a snack bar. Two thugs enter and set about one of them with a cosh. The waitress screams, trips over and falls with a tray full of crockery. The first-aiders are waiting for a 'bus when someone comes shouting for help; they rush in to find the cosh ~oys gone and some casualties left behind. Ambulance not to be loaded. Card oj Instruction.' You are waiting for a 'bus outside a snack bar when you hear a commotion and see two spivs run out. Act as you would in real life. There is some first-aid kit in a W.V.S. Depot next door. Time allowed .' 15 minutes. Patients and Injuries:

Male: Concussion, contused head wounds bleeding from ear and nose, compound 'fracture of right forearm, knife wound of chest, internal haemorrhage from lungs. Female: Scald, left foot and hysteria. Dual Practical Test, Nos. 1 and 2 : Card,' While on duty in a first-aid centre you are called upon to deal with a number of minor injuries. Deal with the cases presented. Time allowed.' 7 minutes. Setting,' First aid post. Equipment consisting of a 'Standard' No. 2 box, complete, two blankets, basin, jugs, towel, cup, pail, one teaspoon, one dessertspoon, one tablespoon and an additional supply of soda bicarbonate. Patients and Injuries,'

Female: Bee sting in the mouth and suffering from nerve shock-4 minutes. Male: Fish hook embedded in right thumb-3 minutes. Dual Practical Test, Nos. 3 and 4 : Card.' You are about to climb a long flight of stairs when you see a man who is descending slip suddenly and fall down the last six stairs. You go to his aid immediately. You have blankets and a first aid box with you. Shelter is available.

Tea and hot water bottles and extra blankets are available on demand. Time allowed,' 7 minutes. Setting.' Flight of steps, adjacent to first-aid post with couch. Patient and Injuries,' Terve shock. After the conclusion of the competitions and the judges had had an opportunity of checking their marking sheets, competltors and spectators assembled in the large ha.ll for the presentation ceremony. The chalT was occupied by Mr.. e. S. Mc~eod, Regional Staff Officer, to the unavOlda~le absence of Mr. A. J. White, Assistant Chief Regional Manager, and he was supported by Mrs. A. J. White, the judges and Mr. e. Greenwood, Regional Ambulance Secretary. In his opening remarks Mr. McLt:od commented upon the growing interest bemg shown on all sides in the ambulance movement. In the Eastern Region (British Railways) two years ago, 2,000 men ~nd women were undergoing training in first aId; last year the number increased to 2,,250, and this year there were 2,800. He believed that this growing enthusiasm was due to the special appeal made by Mr. Greenwood and to the valuable help and encouragement they had received from the varia\ls .officials of the Region. He hoped that this mcre~se would be maintained. 'You teams,' he saId, addressing himself to the members of the competing teams, ' can do much to help the movement by recruiting others to join, ~nd then when they have joined, by affardtng practical help to the new recruits. They are the men and women of the future, and will take your places when you are gone.' .At present they had 225 first aid c~asses runrun.g in the Region, and he would like to see this number increased. He dwelt upon the enormous value of trained personnel in everyday life, and the large number of. lives which are saved annually by first-alders. He then announced the results of the competitions which had been held that day, together with the marks, which were :Teams King's Cross Motive Power Yarmouth Colwick Liverpool Street King's Lynn 'B' Doncaster Traffic Tuxford

Marks

475 450 430 423 410 410 330

Individ ual Oral Marks M. G. Goodliffe (Doncaster Traffic) 36 Mr. J. Pye (King's Cross Motive Power) ... 32 Mr. T. Bloodworth (Col wick) 22 Before the prizes were presented tbe Chairman asked the three judges to give their reports, and called upon Dr. G. O. Hughes, M.e., of Manchester, to report upon the team tests. Dr. Hughes congratulated the teams upon the high standard of work, but, he said, there were faults. He was, in fact, going to be unmerciful in his criticism for it was by criticism that they would learn. He felt sure that the

That Elbow! The phenomenal progress which has been made during the past few years by the Casualties Union and others who are studying the subject of casualty !Dake-up deserves the highest commendatJOn, but there is one problem which ha~, so .far, baffled them, and that is the dl~locatl?n, It must be borne in mind that a dislocatIOn does not present merely the appearance of a simple swelling. The shape of the :vh<?le joint is completely altered, and t~erem !les the difficulty. Moreover,. t~e dl~loc~tIOn can take place in three pnncipal dIrectIOns, backwards, backwards and outwards. and backwards and inwards, each presentlOg a different picture. Before I had an opportunity of examining at close quarters the elbow of ' Mrs. Mopp' in the women's team test at the B.R.e.S. Finals, she had retired to her dressing room and had cleaned up, but it was obvio~s that several of the competitors who exarruned the elbow were inclined to regard it as a simple contusion or sprained muscle, although the reaction of the' patient '- who, incidentally, acted her part well-should have supplied a valuable clue. She had obviously studied the case very thoroughly, and this h~d enabled her to cry out only upon certam definite movements, the significance of which was not always fully appreciated by the competitors. The final diagnostic symptom, however, must be the objective one of the elbow itself. This is a problem for the anatomists and artists, but I am quite certain that their continued combined studies will eventually lead to a satisfactory solution. Unless the artists are actually working in casualty it would be very difficult to arrange for them to inspect some actual dislocations as these must be reduced without unnecessary delay, but I feel sure that they would be able to borrow from the bookshelves of the surgeons who are advising in this valuable department of research some good illustrations to study. Probably a visit to the museum of the Royal College of Surgeons might b~ a.r ranged. . Perhaps it is the appreCiation of thIS difficulty which has induced judges in the past to fight shy. of t~ particular type of injury when frammg thelT tests. F.e.R. members of the teams would appreciate that fact. The team test was not too difficult and the patients (who had been trained 'by the Liverpool Street Branch of the Casualties Union) had shown some good acting, so that there was little excuse f~r some of the oversights in diagnosis, especlaUy the scalds on the legs of the waitress by two teams. He criticised the somewhat rough handling and said that in five of the seven teams one or more members had actually knelt upon the chest of the. patient, despite the fact that he was suffenng from haemorrhage from the lungs. Diagnosis should be carried out with common sense. He was well pleased with the manner in which the hysteria case was got out of the way-' but don't leave the hysterical patient' he added! Dr. J. S. Binning, who judged the Dual Practical Tests, said that he had set the tests expecting a high standard of work, and he had not been disappointed. One or two competitors had been a little uncertain (continued on page 12)

FIR ST AID & NUR SING, MAY/JUNE 1954

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FIRST AID & NURSING, MAY/JUNE 1954

Letters to the Editor DEAR SIR,

Please find enclosed subscriptions for , First Aid & Nursing.' The journal is of great interest to us here, especially in my case. During the war I was a member of 87th Holborn NUrslOg Division, S.J.A.B., also working at Sutton Emergency Hospital, Sutton , Surrey, so the journal keeps me in touch with Home.

British Railways Competition. (Continued) as to the strength of the sod. bicarb. solution which should be used in the case of an insect sting, and he appreciated the difficulty presented by a fish hook embedded in the flesh, especially as the patient resisted his entreaties to see a doctor. The main thing was to keep your head.

The staircase test had been set for the purpose of illustrating one of those things which might be expected. It was quite possible for a person to fall down stairs and sustain no actual injuries, but there was certain to be severe nerve shock. 'You try falling down half-a-dozen stairs,' he concluded. Nobody wanted to ! Dr. A. M. Jamieson, of. Hatfield, who judged the oral tests, was the next speaker. He said that he had not very much to say, although some of the questions were pretty nasty. He would like to have heard some of the competitors more certain of the circulation of the blood. They either knew it or they did not know it. Some were a little confused about the signifkance of the face being either red or white, and also of the type of breathing. Some were somewhat paralyzed when they realized that they had to answer the questions in three minutes. However, on the whole he was quite pleased with their performance. Mr. McLeod then introduced Mrs. A. J. White, the wife of the Assistant Chief Regional Manager, and invited her to present the trophies. Mrs. White explained that she was really deputising for Mrs. C. K. Bird, wife of the Chief Regional Manager, who had been prevented from attending on account of illness. She would, however, do her best. She also had much pleasure in presenting, on behalf of the Region, gifts to the Regional class secretaries in recognition of their work during the past twelve months. Mrs. White was the receipient of a lovely bouquet presented by Mr. Greenwood . Mr. Greenwood said that there were many others whom he .would like to thank, but he could only mentlOn the Departmental and District Officers, who had taken so great an interest in the work, the stewards who had helpedthat day, the' patients' who had been trained by the Liverpool Street Branch of the Casualties Union, his own office staff-and the competitors, without whom there could have been no show !

Work with St. John is the same here as in England, attending public meetings an.d sports, also here all hospital transport IS done by st. John. In our area, all male members do a fortnight's duty of driving, this is voluntary and in addition to their usual occupations, the nursing division members generally accompany the patients, especially females. We also have a Cadet Nursing Division, ages ranging from 11 years to 17 years, who are very keen on First Aid and Home Nursing. During the school holidays, these girls genera]]y work at the local hospital, most of them intend to become nurses, in fact, when they should transfer to the Nursing Division, they generally go off to start training in hospital, they all say that their St. John training is of a great help help to them, this I know is true, because it helped me a great deal when nursing. Would you please insert a request for penfriends for both nursing and cadet nursing members. Thanking you, Yours faithfully, H. M. WATSON (Mrs.), Div. Supt. S.J.A.B., Northern Wairoa, Nursing Division, New Zealand. (Readers who wish to have pen-friends in New Zealand should write to Mrs. Watson. Her address is: Lower Awakine Road, Dargaville, Northland, N.Z.).

SIR, In your issue of Sept./Oct. 1953, ' First Aid & Nursing,' you publish an article by F. G . Reeve, F.Z.S., on Diagnosis, in which he says the pupils of the eyes may be dilated in concussion. In the book' First Aid Competitions and Casualty Make-up' by A. C. White Knox, Principal Medical Officer, St.J.A.A., page 42, he states the pupils are equally contracted. The St. John, 40th edition, page 164, on concussion makes no mention of any change in the pupils. What do you think of these apparent conflicting statements, and what would be your advice to first-aiders who enter Competitions ? A . W. PRICE, F.I.C.A.P. Mr. Reeve replies : Your question raises an interesting point, but I will reply to your last paragraph first. Competitions are judged-or should beentirely upon the teachings of the text-book. As the text-book makes no reference to changes in the appearance of the pupil you need not worry about this point as no judge would expect you to know anything about it. Perhaps I cannot do better than quote from my article on ' Diagnosis ' in the July / August number: 'By sticking to the textbooks no first-aider can go wrong.'

Having advised you upon this point I will now, for your own information, explain exactly what takes place, but you will understand that, for competition purposes, this is entirely' off the record.'

Forming part of the structure of the iris are two sets of muscle fibre, the circular fibres (sphincter pupillae) forming a band one millimetre wide and surrounding the opening which fonTIS the pupil, and the radiating fibres (dilator pupillae), the two sets forming a network. The circular fibres which, when they contract, cause constriction of the pupil, are controlled by the parasynpathetic fibres of the third, or oculomotor nerve, whilst the radiating fibres , which cause dilatation when contracted, are controlled by the sympathetic cranial nerve. By acting one against the other these two sets of nerve fibres are able to maintain a nice balance, preserving, when in a state of health, the unaltered size of the pupil. From this it will be obvious that, should either of these nerves receive injury, control would be relaxed, leaving free play to the opposite nerve. In view of the more exposed position of the oculo-motor nerve it is much more liable to damage than the sympathetic, and in head injuries it is more often this one which is affected, thus causing dilatation of the pupil, although at times the sympathetic does receive injury, resulting in constriction of the pupil. There is, however, another important factor to be considered. Paralysis of the cranial nerves may take place at any time within twenty-four hours of the injury, so that dilatation (and, more rarely, constriction) may not be observed at once. It is, therefore, most important that close observation should be kept upon the patient during this period, and a written report on his condition recorded EVERY HALFHOUR. This will prove most valuable to the casualty officer in his endeavour to assess the damage. I have frequently seen cases brought into casualty in which the pupils were seen to be normal, but no inforrnatiop was forthcoming of the clinical changes which may have taken place during transport from the site of the accident. From the above it will be seen that when all the facts are taken into consideration there is nothing inconsistent in the two statements. I am pleased to note that you have passed the examination of the LC.A.P.

FIRST AID & NURSING, MAY/JUNE 1954

13 ST. DUNSTAN'S CLOCK. On the wall of St. Dunstanin-the \X est in Fleet Street, is the Mt clock showing minutes ever to be made. It was also the Mt clock to have two dials. It was mad.! in 1671.

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I have enclosed an information card which bears an emblem hoping you could reproduce the emblem in a future copy of First Aid & Nursing. The buttonhole badge

~ W does not bear the letters. As it denotes the British Epilepsy Association I think it should be known to first-aiders as forewarned is forearmed. I have made numerous eoquiries and have not found the emblem recognized. Thanking you in anticipation . Yours faithfully, S. J. R. KIRK, No. 94 Dagenham Division, S.J.A.B.

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Answer

Beaders~

queries Answered by Dr. A. D. Belilios

C. A. (Rochdale) writes :Some of my colleagues and I have been discussing diabetes, and we would be pleased if you would advise us on this subject. A patient suffering from diabetes should have a card to sho w that he is a diabetic, and he may have a syringe and insulin and sugar, apart from this if he is unconscious how are we to know if he needs insulin or sugar? What are the signs and symptoms of overdose of insulin and the signs and symptoms of too much sugar? Answer

Your question would take a complete article to answer but sufficient information is given in all standard text-books on first aid and will not be repeated on account of space. If the patient is unconscious, he obviously cannot be given fluids by the mouth in any case, and to give insulin in such an emergency would be beyond the scope of first-aiders. In a doubtful case. tests of the urine and blood und~rtaken by a doctor answer the problem. If the patient is not completely unconscious and able to swallow, glucose can be safely given in either condition, since the doctor can easily cover excessive glucose with more insulin if the result of his tests show that diabetic coma is present.

R. S. G. (Exeter) writes :On page 110 of the S.J.A.A. textbook, we are told that haemorrhage from the ear channel generally indicates a fractured base of the skull and we are advised to incline the head to the affected side and apply a light dressing over the ear. What is the reason for this advice ?

The main reason is to prevent sepsis by allowing the blood to drain outwards with the germs that it picks up as it flows along the ear channel. A second reason is that it is better for the blood to flow outwards than to accumulate at its source where it could possibly aggravate subsequent compression of the brain.

C. B. (Dundee) writes : Our manager, aged 35, was taken suddenly ill with severe shortness of breath, bad pain in his wrists and shock. As first-aider to the works, I phoned a doctor who advised me to dial 999 and ask for an ambulance to remove the patient to hospital. This seems strange advice and I should be glad to know what the doctor had in mind. Incidentally the patient was detained in hospital. Answer It is, of course, not possible to

give a diagnosis but from the history, it sounds as if the patient was suffering from a heart attack such as coronary thrombosis. Removal to hospital was essential for observation and immediate treatment. If, as I imagine, a hospital was near at hand, the 999 service was the quickest procedure particularly in these days of shortage of hospital beds. Moreover, oxygen is carried on an ambulance and could have been administered on the journey.

J. B. (London) writes : I should be very grateful for your opinion on a case I recently treated. The man came off his bicycle and complained of severe pain in his shoulder. All the sy mptoms of a dislocated shoulder were there as on page 155 of the S.J.A.A. manual. I gave treatment and took him to hospital. The hospital doctor was sarcastic to me and said that I should have given the first aid for a fracture. What is a poor fellow to do ? Answer

You do not give sufficient information for the position to be assessed, e.g. , if fixity, the position of the arm, etc. But on the whole, the hospital doctor was wise (though not in his sarcasm), because (a) it is extremely difficult to distinguish

between a dislocation and a fracture and (b) both injuries are often present together. Hence it is good first aid to treat for the more serious injury likely to be present: often only an X-ray will settle the problem.

M. W. (Belfast) writes :I have heard that there is a new treatment for high blood pressure. Can y ou give me any information please? Answer

The word 'new' is not quite correct since a drug for this complaint has been in use for several years. The remedy- called technically Hexamethomium - is being used in several forms with satisfactory results but much research has been and is still being carried out to discover the best method of administration, i.e., tablets or injections. There seems little doubt that the future of the drug is very promising for many kinds of cases.

J. C. B. (Edinburgh) writes :I am the Matron of a school and am taking some children to camp in the near future. Two o/them are said to be suffering from athletes foot . Can y ou give me some information on this subject please ? Answer

This is a common condition and often very difficult to cure. It is caused by a variety of fungus and is probably spread by direct contact and also by walking on damp floors , mats, etc., which have been used by other sufferers from the disease. Although there are several varieties, the most common takes the form of the skin peeling, and cracking between the toes; sometimes painful sores develop. The treatment is essentially a matter for the doctor.

J. B. (Manchester) writes :I wonder if you would settle an argument which has occurred between two of us. My friend recently undertook first aid for a dog bite but · did not advise medical attention because the patient told him that he had received an injection 0/ anti-tetanic serum for a garden wound several months llefore. This he thought would prevent lockjaw occurring in the second accident and that in any

FIRST AID & NURSING, MAY{JUNE 1954

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case a second injection would be dangerous. I personally did not agree with him and thought that a doctor's advice should have been obtained.

FIRST AID & NURSING, MAY/JUNE 1954

First~Aider~s Crossword No. 11 Compiled by W. A. Potter

Nineteenth Edition. Campletely revised. 261 st thousand 286 pp., 286 illustrations, some coloured, 6s. 6d., post 4d. WARWICK AND TUNSTALL'S

Answer

FIRST AID

I am afraid your friend acted very improperly. Any case such as this should be referred to a doctor or hospital. The value of the first injection of A.T.S. would have worn off completely and in any case precautions against the rare danger caused by a second injection would have been observed by the doctor. Your friend exceeded his limitations as a first-aider.

TO THE INJU~ED AND SICK

Edited by A. P. GORHAM, M.B., Ch.B., M.R.C.S. Police Surgeon, City and County of Bristol

'FIRST AID' WALL DIAGRAMS 26 X 40 in. A-G Anatomy and physiology. H-J The triangular bandage. K, L The roller bandage. M, N H.emorrhage and wounds. 0, P Dislocations and fractures Q, R Transport. S Artificial respiration.

First-Aider in IndustryContinued from page 1 as possible should be competent to give first aid so that if the person in charge of the bo~ is temporarily absent there is no delay in applying a dressing ; but the fact that the first aid has been given should be reported at the earliest moment. A record must be kept of all injuries treated by first aid. Record Keeping Records must be kept for the State and for the management. They should include the name and check number of the injured person, the nature of the injury, the time of its occurrence and the time when it was first treated, an indication, where possible, of the cause of the accident and what happened to the patient subsequently, for example, whether he returned to work, went to a hospital or consulted his own doctor. Daily, weekly or monthly summaries may also be kept. These may be a valuable guide to those responsible for precautionary measures and accident prevention, for they show at a glance what type of accidents occur most frequently , in which department or on which machine, and the time lost or disability that followed. An analysis can be made and deductions and interpretations can be available to both management and Factory Inspectors. Every accident causing loss of life, or disablement for more than three days, must be reported to the Factory Inspector. First Aiders in the Ambulance Room When only one nurse is employed, a person qu alified in first aid may act as her assistant and take charge during her absence. This first-aider will probably not be employed in any other capacity. Alternatively, a rota of factory employees with first aid qualifications may work in the ambulance room. Sometimes, girls who are not yet old enough to train as nurses work as , auxiliaries ' under the direction of an industrial nurse until they are old enough to enter hospital. First Aid on Night Shifts In industries where a maintenance staff are on night shift, those with first aid qualifications can be responsible for treating casualties at certain times; for it would be uneconomic to have a qualified nurse on duty if the night shift were less than 300 workers. If a rota were kept there need be little interruption in each man's regular work.

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ACROSS S. Drive away (5) 8. Consultants sip ices last (11) 9. Warning-a dangerous woman (5) 10. Hearing aid for the doctor (11) 11. Often find a dou btful fracture . .. (1-4) 12. Naturally occurring they are (4) sore if disturbed 17. State in which patients falsely thinks he has serious disease (12) 20. Chilly comfort for injured joint (4,8) 22. Painful infection when best yeast loses its animal part ... (4) 24. Board for spinsters (5) 29. He meant a tax change for these infectious diseases (11) 30. Certainly not to be shown before the patient (5) 31. Bactericidal and health-giving rays... ... (5-6) 32./ Modified drain at the lowest point ... (5)

(S ) Villa at Birmingham ... (5) Sex takes two directions here (4,3) 6. Necessary for healthy 7 7. A guinea round prescribed oint(5 ) ment will do for these organs 8. The higher figure of the B.P. (8) reading 13. Cast off a small building (4) 14. Rough measure for the home (S ) nurse .. . IS. Field of opportunity for action (S ) 16. Said to be filled, not with red marrow, but with 'black ingratitude' ... (5) 18. Vulgar sleep, maybe without a bed (4) 19. Unnatural change could be tart face (8) 21. Away from the wind there's a (7) section of the hospital (6) 23. Lags behind and is ill in the end 24. May afford a clue in cases of poisoning (S) DOWN 2S. A fractured neck is common 1. Shock is always apparent with here .. . (S ) these injuries (6) 26. Adipose .. . (S) 2. To be considered in studying 27. Mixture of meats is cause of patients surroundings (S) many serious scalds ... (S ) 3. Embarrassing dilatation of facial arterioles (5) 28. Margin of the external ear (S ) (Solution next issue)

4. S.

SOLUTION TO CROSSWORD No. 10 ACROSS DOWN S, Lighter; 8, cooperate; 9, gapes; 1, Aconite; 2, worries; 3, beneath ; 10, nerve shock; 11, rapid; 12, trea.t; 4, baths; 5, leech; 6, headache; 7, IS, haemorrhage; 19, cleanliness; 23, evenings; 13, amend; 14, arcs; 16, ails ; ovule; 24, uvula; 27, Schick test; 17, clavicle; 18, Pallmall; 20, sockets ; 28, ocean; 29, first turn; 30, new leaf. 21, humerus; 22, West end; 2S, scoff ; 26, liars.

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An entirely new design in ambulances with many unique features. It incorporates a new low loading top stretcher gear which enables two orderlies to load and elevate patients, the smooth action gear eliminating shock or jolts. The wide centre gangway provides space for three wheel chairs, eaSily loaded by the ramp and winch.

The flexible accommodation is (a) 4 stretcher and 4 sitting patients (5 stretcher cases in an emergency); (b) 2 stretcher and 8 sitting patients; (c) 16 sitting patients. Built on Austin, Commer, Bedford or Ford chassis. Adequate provision for storing stretchers, blankets, medical supplies, etc.

AMBULANCE & MOBILE UNIT BUILDERS Telephone: LiBerty 2350 & 7058

No. 70 I t Vol LIX

JULY/AUGUST 1954

ANTIPEOL CUTANEOUS OINTMENT is a prepara-

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T AID

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Printed b~ HOWARD, JONES, ROBERTS & L~ETE, Ltd., 26-~8 Bury Street, St. Mary Axe, London, E.C.3, and published b .v the Propnetors, DALE, REYNOLDS & Co, Ltd., at 32 Finsbury Square, London, E.C.2, to whom alJ communications should be addressed.

tion which incorporates the sterile broth filtrates of the three infective microbes in an ointment base of proved efficiency further to accelerate the process of rapid healing. AS

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for burns and s<;alds,

ANTIPEOL OINTMENT is both non-adhesive and

PRICE FIVEPENCE

3/3 per Annum POSt FrH

bactericidal thus obviating the need, when not convenient, of changing the dressings every day. FOR CUTS, ABRASIONS, BOILS and numerous skin infections, Ai'ITIPEOL is unquestionably the remedy. It is already in widespread use by the medical and nursing professions in many parts of the world.

ANTIPEOL is therefore

an essential component of every First Aid and Nursing Kit.

antipeol cutaneous ointment Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTJPEOL for ocular infections; DETENSYL for reducing arterial tension. MEDICO.BIOLOGICAL LABORATORIES LTD., CARGREEN RD., SOUTH NORWOOD, S.E.2S

We congratulate • •

FIRST AID & NURSING, JULY/AUGUST 1954

GARROULD'S for the

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"PORTLAND" AMBULANCE GEAR The Gear iliustrated(A.B.C.D.} carries two stretchers on one side of Ambulance. leaving other side clear for sitting patients. The UP AND DOWN action is quick and easy for loading or unloading. A. Shows the two stretchers in position. B. Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear with the top stretcher frame hinged down for use when only one stretcher care is carried. D. Shows the same position as in "C' only with cushions and back rest fitted for conval~cent cases.

Where Ambulances are required to carry four beds two Gears are fitted. one on EITHER SIDE. and the same advantages apply as described above. Full catalogue ff Ambu lance Equipment No.7 A will be sent on request.

~I---------------

65, WIGMORE STREET, LONDON, W.I 'Phone: WELbeck 0071 (late GREAT PORTLAND STREET)

W.2

Wounds and their treatment

Casualties Union

N.H.S.R. mobile first aid competition

Notes on advanced physiology

Competition report

Readers' queries

First-aider's crossword...

;'I,

no you know

that • ••

North East Somerset H.M.C. (Keynsham hospital) who won the National Hospital Service Reserve First Aid Competition held in London on July 3rd (see page 4).

. . Mrs. A. E. Sampson, Superintendent of the No. 17 Leyton & Leytonstone Nursing Division, S.J.A.B., on completing 25 years in that position. Mrs. Sampson is seen here cutting a cake at a party recently held at the Division's headquarters to honour her quarter century as Superintendent.

1. H the capillaries of the body were placed end-to-end they would stretch to a distance of 62,000 miles-2i times round the earth?

2. The correct method of awakening a patient without causing irritability is by gentle pressure on the vagus of the ear, when he will often awake with a smile? 3. Spinach produces a green stool and carrots a reddish one ? 4. Many cases of food poisoning are caused by contaminated duck eggs, which should, therefore, be boiled for at least 10 minutes. 5. Cortisone, the new treatment for rheumatic arthritis, is made from the liver of the ox ? 6. The superficial area of the lungs (tubes and alveoli) necessary for the oxygenation of the blood in all the capillaries of the lungs is 150 sq. yds.

. . all the teams who took part in the S.J .A.B. Finals at the Central Hall in June, especially Wolverton, Bucks, who won the Dewar Shield (see page 8) and the Brighton Police team (left) who won the Symons Eccles Cup.

FIRST AID & NURSING, JULYjAUGUST 1954

COURSE IN ELEMENTARY FIRST AID

Wounds and their treatment By A. D. Belilios M.B., B.S. (Land.), D.P.H. (Eng.)

Stopping Bleeding HE last article in this series described the treatment of wounds but hardly referred to stopping bleeding, or h.aemorrha~e as it is called techmcally. ThIS month, therefore, is devoted entirely to methods of controlling haemorrhage. Loss of blood from the body may originate from many situations. It may come from wounds which have affected the sbn, or arise from organs such as the nose, lungs, stomach, etc. This article deals with bleeding resulting from wounds of the skin, commonly called external haemorrhage. External haemorrhage may come from arteries, veins or capillaries. The appearance of the blood and the manner in which it flows usually enables the first-aider to decide on the type of blood vessel that has been injured. If, for example, a large artery has been severed, the blood is bright red in colour becaus~ it contains oxygen; if the vyssel is near the skin, the bleeding occurs in spirts corresponding to the beats of the heart. There is considerable force behind each spirt which may travel for some distance. In bleeding from a vein, however, the blood is dark red in colour and flows in a steady stream and with less force than in the case of bleeding from an artery. Capillary bleeding produces a steady ooze like that which results from a cut caused by shaving. Since capillaries are so numerous, it is impossible to have bleeding from one capjllary alone; usually, even in a slight wound, a number of these vessels are severed. It is important to realize that bleeding is usually mixed. Many arteries and veins run alongside each other, hence in larger wounds both varieties of blood vessel are damaged at the same time, while

some degree of capillary bleeding is also present. So far, we have described the main characteristics of the bleeding which occur from the different bnds of blood vessels; these characteristics are often called the local physical signs of haemorrhage. But it must not be forgotten that bleeding, particularly if severe, seriously affects the general condition of the patient producing what are known as the general symptoms and signs of bleeding. These include those of shock such as a feeling of faintness or actual unconsciousness, pallor, thirst, a weak and feeble pulse, a lowered temperature, shortness of breath, etc. In more serious cases, there may be 'fighting for breath' (air hunger), restlessness and dimness of vision. Treatment The treatment of bleeding is divided into two classes-that for severe and slight haemorrhage. There is DO need to say much about slight bleeding, since it is usually capillary in origin and easily controlled by a firm dressing. But it must be emphasized that if it is allowed to continue for a prolonged period it can have a serious effect on the patient. Those, for example, who suffer from the disease of the bloodcalledhaemophilia, a complaint in which the blood has lost its power of clotting, may die even from a slight wound. Severe Bleeding Severe bleeding is a priority injury and demands immediate attention since it may lead to death. Methods of stopping it may be classified as follows :(l) Direct pressure on or around the wound with (a) the fingers or thumbs (digital) and (b) pads. (2) Application of a constrictive bandage above the level of the heart side of the wound.

(3) Pressure points. (la) Direct digital pressure.-Firm pressure on the wound using the digits, preferably the thumbs, is usually successful, but it cannot be applied to large wounds, although if necessary the pressure can be made with the palm of the hand. Whenever possible, a piece of clean or sterile material such as gauze or lint, should be placed over the wound before the pressure is applied. This prevents contamination with germs derived from the hands and reduces the risks of sepsis. Direct pressure must not be applied if there is a foreign body or a fracture associated with a fragment of bone which projects. In these cases, the bleeding may be controlled by pressure around the wound; if unsuccessful, methods 2 and 3 must be employed. (lb) Digital pressure can only be a temporary measure to be used until equipment has been obtained and the first-aider is ready to deal with the wound. A firm pad, applied over a sterile dressing, should be used whenever possible, as the final method. This pad can be made from several thicknesses of lint, a liberal wadge of cotton wool or a triangular bandage folded to a suitable size. It must be bandaged firmly over the wound but not more tightly than is necessary to stop the bleeding. Some dressings, e.g., the first field, shell and mine, have ready made pads. If blood continues to ooze through the dressing, showing that the bleeding is not under control, a second or even third pad and bandage may be applied over the first, each being a little more firmly secured. The first pad should never be removed since this would disturb blood clots which have already formed and are assisting in the natural arrest of the bleeding.

FIRST AID & NURSING, JULY/AUGUST 1954

Applying a second pad over the first as above described is frequently necessary in the dee~er wounds ~nd has as its object, forcmg the dressmg into the depths of the wound. Doctors sometimes pack these wounds with .sterilized gauze up to a level slightly above that of the skin before applying the pad and bandage but this procedure should only be undertaken under aseptic precautions. . Naturally there are exceptIOns to applying direct pressure with a pad and bandage; these are the same as in di aital pressure and are overcome by building up dressings around the wound, so that when the firm bandage is applied, no pressure is exerted on the wound itself and complications are avoided. The bandage itself can with advantage be applied in a diagonal manner for the same reason. Scalp wounds in which a fracture is suspected, or a foreign body present, are treated by applying a ring pad which, when bandaged in position, supplies pressure all around the wound but not directly on it. Whichever method is employed, careful observation must be maintained to see that the bleeding remains under control. The oozing of blood through the dressing, an increase of the pulse rate or failure to show recovery from shock may be pointers that bleeding is still continuing. (2) Constrictive bandage.-This is a rubber bandage about 4 ft. long and 2t in. wide; it is provided with a tape attachment at the end for fastening after it has been applied. It is really a variety of tourniquet and should only be used in essential cases such as when there is severe and uncontrollable haemorrhage, as may occur in an amputated limb. The bandage should be applied round the limb not more than a few inches about the wound. It should not be applied any more firmly than is necessary to stop the bleeding since it damages the underlying tissues, is painful and increases shock. Every twenty minutes the bandage must be relaxed, it must be retightened if the bleeding begins again; otherwise it should be left in position and careful observation kept on the wound. A constrictive bandage must never be covered with a dressing which rrught lead to its

presence being forgotten particularly when a case is passed on from one team to another, e.g., from firstaiders to other casualty workers. A constrictive bandage left on too long may cause most unpleasant complications. For the same reason, notes should be kept of the times of application and relaxation. (3) Pressure points.-A pressure point is any situation in the body at which an artery can be pressed against a bone and the flow of blood along the vessel arrested. There is some difference of opinion among those interested in first aid in regard to the use of pressure points. Stopping bleeding by the use of a pressure point is valuable as an immediate procedure since it enables the first-aider to examine the wound and to make preparations for its treatment. Some authorities, however, recommend the use of a pressure point when the other methods above described are unsuccessful or cannot be used. There are a number of pressure points in the body but the use of those below the elbow and knee are generally unnecessary except when direct pressure cannot be applied, e.g., when there are mUltiple injuries or the wound is complicated by a fracture or foreign body. The pressure point used should always be that nearest to the wound and on the heart side. The thumb should generally be employed to make the pressure which, of course, must be accurately applied to the correct position. This involves knowing the exact course of the chief arteries of the body and the places at which they can suitably be compressed against the bone. A first-aider should practice finding the pressure points on his own body and those of his friends until he is so accurate that he can make immediate pressure without fumbling even in a subdued light. It is only by frequent practice of such a nature that the student will be really efficient in an actual case. Pressure points cannot be used for a long time since the first-aider's hands tend to tire after a short while. Should it be necessary to keep up pressure for long, the help of assistants will be necessary, each taking his turn at pressure. The (continued on page 16)

CASUALTIES UNION The Minister of Health's Trophy. Horse Guards Parade was full of ambulances for this contest and transparent houses were provided in which the competing teams had to work. These were constructed from portable traffic barriers which served to outline the walls and doorways but which left the competitors in doubt about windows and other fittings but provided an excellent view for the hundreds of spectators. Casualties Union provided the 56 trained , casualties' demanded by the tests, and sixteen teams competed. The cases included internal haemorrhage from an internal injury, extensive abrasions on face, grazed hand with glass embedded in the wound, open fracture of forearm, shock, epilepsy, burns on front of chest and fractured clavicle. Mr. P. G. Sargeant was responsible for Casualties Union arrangements under the medical direction of Dr. J. E. Haine. The Minister of Health, Dr. lain Macleod, paid tribute to all the services who had collaborated in putting on the contest and expressed thanks to Casualties Union for ' the realistic and horrifying casualties ' whose acting had done so much not only for the success of the final contest but also for the local and regional contests on the way to the final. . . It is interesting to note that an lDcreasmg number of groups from Scotland to the South Coast are seeking the co-operation of Casualties Union in staging exercises for training purposes. Buxton Trophy. Regional contests were held throughout the Country at the beginning of July to select from 96 entrants the teams to compete in the final round to be held this year at Pinewood Film Studios, Iver Heath, Bucks, on Sunday, 3rd October, at 2 p.m. The twelve regional contests were well received and some interesting contests resulted. The first aid problem concerned a crazy young man who in gallivant0g round a cricket field on a motor cycle durmg an interval in the play, lost control knocked down a spectator and came to grief himself. The spectator suffered concussion ~nd a grazed ankle while the rider got a.co~plicated fracture of the ribs with bleedmg mto the lung. The diagnosis cases were locked knee, fractured jaw, perforated ulcer, lumbago, dislocated jaw, poisoned finger. The enthusiasm with which these contests were received may be indicated by the f~ct that in several areas permanent trop~es have been presented for annual competlt~on. Spectators will be welcomed at the F~al and tickets (2,6 each) may be had by sending addressed envelope with remittance to Miss E. E. Johnson, 8 Woodcote Park Avenue, Purley, Surrey. The successful teams were : . Truro: 1st S.J.A.B. Redruth Nursmg. 2nd S.J.A.B. Redruth ' A ' team. Winchestel': 1st B.R.C.S. Andover, Hants 5. 2nd S.E. Electricity Board, Mid Sussex. WallIngton: 1st S.J.A.B. 17 Wimbledon. 2nd B.R.C.S. Cheam, Surrey, 136. Putney: 1st S.J.A.B. 75 Southend. 2nd Ind~stry, London Transport 'A.' Readmg: (continued at foot of third column, page 11)

FIRST AID & NURSING, JULY/AUGUST 1954

FIRST AID & NURSING, JULY/AUGUST 1954 General layout of unit in buildinguse of rooms, etc. (d) Reception, documentation, treatment and disposal of casualties. Hardly had these preparations been completed when the faked casualties began to arrive, some on stretchers, some walking but assisted by wardens, many of them presenting most ghastly sights. They had been faked by members of the Casualties Union. Yes, this was also a great day, a day of triumph, for the Casualties Union, for they had been called upon to provide no less than 58 casualties for this elaborate exhibition. However, we will leave the arena for a moment and visit the large marquee which had been assigned to the Casualties Union. Here I met Mr. P. G. Sargeant, the general secretary of the Union who, with his assistant, Miss W. A. Elston, was in charge of this great army of workers. Mr. Sargeant explained to me the organization' of the work without which success would have been impossible. In the marquee I saw eight ' tables covered with paints, brushes, plasticine and other modelling clays, rabbit bones, splinters of wood and a vast amount of impedimenta which would have bewildered the average layman. Presiding over each table was a , dresser' who was both a skilled first-aider and an artist. Grouped around each dresser's table were the men and women which he or she had to transform into , casualties,' each 'casualty' being both skilled in first aid and also an actor or actress. These casualties had been trained to simulate the sufferings of victims from various causes- fractures, haemorrhage, shock, cerebral concussion and compression asphyxia, epilepsy, etc., and every one was ~ speci.alist. Truly, casualty faking and acting has, ill the space of ten years, developed into a fine art. Returning to the arena I watched the teams at work, and through the courtesy of Mr. Heald and his assistant press relations officer, Mrs. Samson, I was enabled to study the operations of the competitors at close quarters, and noted the detail which could not have ~een seen from the spectators' ring. Mter a rapId survey of the' premises' the medical officer would indicate to his trained nurse the layout of beds, tables, chairs cupboards etc., which, jn his judgment, ~ould prov~ mos! con.vement.for all, and she would pass detatled mstructlOns to the auxiliaries who worked with the greatest precision. Then, as the casualties were carried in they were p~aced on beds or in chairs, their cases diag.nosed by the doctor and treatment camed out under his direction. After this th~y were sorted out, the most serious cases bemg ~ent to hospital, the less serious sent to ~heir homes either by sitting-case car or assI~ted by ambulance personnel. It was ObVlOUS to all that such co-ordination could only have been achieved as the result of m~n~ m~nths of study and training. Surely thls lD Itself was sufficient reply to those who argue that Civil Defence is unnecessary.

(c)

By a Special Correspondent

N.D.S.R. mobile first aid eompetitio ALTHOUGH these lines will be read for the most part by trained first-aiders and nurses, yet there may be some amongst my readers who have not yet taken these qualifications, and it is to them I would direct this question. Have you ever imagined yourself standing, helpless, beside a loved one who has. been seriously injured in a blitz, hoping and waiting for the arrival of someone who would know exactly what to do ? What would be your feelings if that loved one were to pass away solely for want of the treatment which you might have given had you but known what to do? Would you feel that you could never forgive yourself ? Yes, retribution would come too late. On Saturday, 3rd July last, on Horse Guards Parade, we watched the performances of 160 men and women who will never have to express that regret, men and women who had prepared themselves against such a contingency by training in the National Hospital Service Reserve. They were the finalists in the N.H.S.R. Mobile First Aid Unit Competitions for the Minister of Health's Challenge Cup, and were the winners of their respective Regional Competitions. Each team consisted of a medical officer, a trained nurse and eight nursing auxiliaries of the N.H .S.R. Transport of each team consisted of a 30 cwt. van for equipment and a station wagon or two cars for the team. It was self-contained and carried everything it would be likely to need. The teams competing were: MidGlamorgan H.M .C. (Maestag General Hospital) representing South Wales Region; Rochdale and District H.M.e. (Team No . 1) representing Manchester Region ; South

West Middlesex H.M.C. representing N.W. Metropolitan Region; Redhill H.M.C. representing S.W. Metropolitan (Eastern Area) Region; Bournemouth and East Dorset H .M.C. representing S.W. Metropolitan (Western Area) Region; Derby No. 2 H.M.C. representing Sheffield Region; East Liverpool Op. Gp. (Broadgreen Hospital) representing Liverpool Region; Wrexham H.M.C., representing North Wales Region; South East Kent H.M.C. representing S. E. Metropolitan Region; Enfield Gp. H.M.C. (Team No. J) representing N.E. Metropolitan Region; Ipswich Op. H.M.C. representing East Anglian Region ; North East Somerset H.M.e. (Keynsham Hospital) representing S.W. Region; Coventry H.M.e. (St. Luke's Hospital, Rugby) representing Birmingham Region; Hexham and District Op. Gp. representing Newcastle Region; Bradford 'A' Op. H.M.C. representing Leeds Region; Oxford and District H .M.C. representing Oxford Region. At 2.15 p.m. the sixteen units were inspected by the Minister of Health, the Rt. Hon. lain MacLeod, M.P., and what a sight it was. The 160 competitors, together with their reserves, were drawn up on the south side of Horse Guards Parade, whilst behind each unit were to be seen the respective equipment vans and the two cars for members of (he teams. Mr. MacLeod shook hands with every member on parade, and then passed to the drivers of the County of London and Westminster Divisions Civil Defence Corps who were to render valuable assistance in the Competitions. At 2.30 p.m. the Competitions commenced, and the manner in which the

whole programme was carried out to time was a tribute to the organizing abilities of Mr. Heald and his colleagues. The underlying idea was that each unit in turn was assumed to have been called out by the Civil Defence Controller followin g an enemy attack, and was required to set up a temporary first aid post in a mock building and deal with a stream of faked casualties which would be carried in by stretcher parties. In order to get through this gigantic programme in a reasonable time it had been arranged to judge four teams at a time, and the competition arena had been divided into four rectangles, each con· taining a mock building. Each team in turn was led into its part of the arena by a motor-cyclist provided by the Ministry, who wore a number corresponding to that of the unit he was leading. Upon arrival at the mock building the medical officer in charge of the team had to report to the Damage Control Officer awaiting the team at the entrance to the mock building, who gave him any information available at the moment concerning the incident. The team would then set to work unloading their equipment, which consisted of cupboards, packing caSe:5 and other containers in which were packed drugs, dressings, bandages, splints, heating apparatus, stretchers with trestles for beds, blankets, buckets, bowlsin fact everything which might be required to deal with any emergency. Marks were to be awarded for :(a) Turnout of personnel , discipline upon arrival, evidence of clear apportion· ment of duties. (b) Method of unloading, unpacking and laying out of equipment.

At 4.45 p.m. the Minister of Health

mount~d the platform, and was supported

The winning team- N o E. Somerset H.M.C., during the competitions.

by MISS M. P. HornSby-Smith UnderSecretary, Ministry of Health, AId. Charles P. Russell, e.V.O., J.P., and Mrs. Russell, ~ayor and Mayoress of Westminster, with SIr Parker Morris, L.L.B., Town Clerk of The runners-up-Bournemouth and East Dorset H.M.C.)

Teams in action

Derby No. 2 H .M .C .

Bradford' A' Gp. H.M.C.

Oxford and District H.M.C.

Westminster, Sir John Charles, M.D., D.P.H., Chief Medical Officer, MIlllStry of Health, and Lady Charles, Miss Cockayne, Chief Nursing Officer Ministry of Health, Maj. A. e. Whit~ Knox, O.B.E., M.e., M.B., Ch.B. , Chief Medical Officer, and Mrs. Romer Lee, the St. John Ambulance Association, Maj. F.~ ..C.P.,

General L. A. Hawes, e.B.E., D .S.O., M.C. , M.A., Controller, Home Department, and Mr. Bryans, Director, the British Red Cross Society, Sir Frank Newson and senior officials of the Home Office, Sir Ernest Rock Carling, M.B., F.R.C.S., and representatives of the various Regional Hospital Boards of England and Wales.

FIRST AID & NURSING, JULY/AUGUST 1954

6 Mr. MacLeod commenced his speech in a humorous vein by saying' The only reason I have been asked to speak is t? allow ~he judges time to complete th~lf markmg sheets.' Continuing more senou.sly, however, he told his audience that th~s. was the first really National CompetItIOn for N.H.S.R. Mobile First Aid Units, as last year it had been confined to only four hospital regions. This year, however~ over 200 teams had entered, and the SIxteen teams which had been seen in the arena. that day were the winners of the RegIOnal Contests which had been held throughout the country beforehand. Enthusiasm was growing, and he felt quite sure that double this number of teams would enter for the Competitions next year, for it had now b~en decided to make it an annual event. Whilst we had enjoyed watching the skill of these sixteen teams which had won through to the Finals it must be borne in mind that in many cases the losers had run them very closely at the Regionals. He referred to the sporting spirit which had been shown throughout, for many of the teams which had been defeated at the Regionals had travelled to London that day, some of them at their o~n expense, in order to cheer the teams which had beaten them. Of these he could only mention a few- Worthing, Woolwich, Orpington, Portsmouth and Fareham, Wigan, Canterbury and Taunton. He went on to say that, apart from the emergencies of war, there w~r~ emerg~ncies in peace time. Over a mIllion accIdents took place annually which demanded hospital treatment, and a large percentage of these could be dealt with beforehand if only there were someone present who had been suitably trained. 'It is training that telIs,' he emphasized, and this very training was being provided by the National Hospital Service Reserve. Civil Defence was part of our strength, and there would always be, in our national life, an important part for Civil Defence to play. The Competitions that day had been a great success, and there were so many who had contributed to that success. He would like to have thanked all who had helped, but this was impossible. He would, however, mention a few: First of all the N.H.S.R. was only made possible by the co-operation of the St. John Ambulance Association and the British Red Cross Society. The Casualties Union had done valuable work by training and providing the casualties. The County of London and Westminster Divisions Civil Defence Corps had provided transport and drivers, and the members of the Women's Voluntary Service had superintended the arrangements for refreshments with their usual calm and confidence. He wished, also, to thank St. George's Hospital for providing and staffing a First Aid Post in case of any real casualties which might have occurred amongst the spectators, and also the Band of the Irish Guards (Captain c. Jaeger, Mus. Bac., L.R.A.M., A.R.C.M., Director of Music), by kind permission of Col. D. M. L. Gordon-Watson, C.B.E., M.C., Lt. Col. Commanding Irish Guards, for having provided a splendid programme of music. Finally he thanked the vast crowd of spectators who had shown so much interest by corning to see the Competitions. The results of the Competitions were announced as follows :-

Notes on advanced proceeding to discuss BEFORE the mechanics of respiration it might be advisable to dispel one or two misconceptions respecting the diaphragm. You have learned from your text-books that this is a strong muscular membrane separating the contents of the thorax from those of the abdomen, but it is not, as appears to be generally believed, moving up and down in an emI?ty space. It is actually in contact :V:1th the viscera of these two caVItIes, except for the peritoneum (accent on the 'ne,' please), or lining membrane of the abdomen, which separates it from the liver on the right side and the end of the stomach, the

1. 2. 3.

North-East Somerset H.M.C. Bournemouth and East Dorset H .M.C. Rochdale and District H.M.C. (Team No.1). 4. Enfield Group H.M.C. (Team No. I), tied with5. East Liverpool Operational Group (Broadgreen Hospital). 6. Bradford 'A' Group, H.M.C. 7. Oxford and District H.M.C., tied with 8. Wrexham, Powys and Mawddach H .M.C. 9. Redhill H.M.C. to. South-West Middlesex H.M.C. 11. Ipswich Group H.M.C. ] 2. Derby No.2 H.M.C. 13. Coventry H.M.C. CSt. Luke's Hospital, Rugby). 14. Hexham and District Operational Group. 15. Mid-Glamorgan H.M.C. (Maesteg General Hospital). 16. South-East Kent H .M.C. Then, amidst the cheers of the spectators, the winning team, N.E. Somerset H.M.C. CKeynsham Hospital) paraded before the rostrum and was presented with the Minjster of Health's Challenge Cup by Mr. MacLeod, who shook hands with each member as he congratulated them upon their success. He also shook hands with all the members of the runners-up, Bournemouth and East Dorset H.M.C., and finished with words of encouragement to all the other competing teams. Mr. S. A. Heald, Public Relations Officer, Ministry of Health, is to be congratulated upon the excellent arrangements for the Competitions for which he had been responsible. May I add this personal appeal? Get in touch with your local H.N.S.R. Organizer without delay. He or she will be pleased to have a chat with you.

spleen and the left kidney on the left. On its upper side lie the two lungs, the right being about ! in . higher than the left at the top of the arch formed by the diaphragm, and the heart, which lies principally on the left side. The pericardium, or covering membrane of the heart, and the pleurae, or covering membranes of the lungs, are continuous over the remaining upper portion of the diaphragm. In other words, the diaphragm is really sandwiched between the organs of the thorax and those of the abdomen. Its perimeter is attached to the lower end of the sternum in front, and to the costal cartilages and ribs in front and at the sides. Behind it takes a sudden downward turn and becomes narrow like the handle of a fan. This 'handle ' divides into two portions known as crura (plural of crus) which are attached to the bodies of the lumbar vertebrae. Although in a state of health the right and left sides of the domed portion of the diaphragm rise and fall in unison, they are operated independently, being controlled by separate sets of nerves, a useful provision in many cases of tuberculosis, when one lung has to be artificially collapsed by the surgeon by cutting the nerves on that side. The other principal factor governing the mechanism of respiration is the action of the ribs, although all ribs are not movable. The firs t pair of ribs are fixed by the structures in the vicinity of the neck. The next four pairs of ribs are drawn upwards by the contraction of the external intercostal muscles, which are attached to the outsides of these ribs, and the upper serratus posticus, which extends from the spines of the seventh cervical and first three dorsal vertebrae to the upper borders of the second, third, fourth and fifth ribs. The lower ribs are raised partly by the action of the external intercostal muscles and partly by the internal intercostal muscles, which are attached to the insides of the ribs, but the raising of the whole of the ribs is assisted by the contraction of

FIRST AID & NURSING, JULY/AUGUST 1954

p hysiology

By F. C. Reeve F.Z.S., F.R.E.S.

the levatores costarum (12 pairs) which run from the transverse processes of the seventh cervical and the ' 11 upper dorsal vertebrae to the two ribs next below each. At a recent competition I watched two members of a team performing artificial respiration, using the Drinker method (modified), but, instead of synchronizing their movements one was attempting to induce inspiration, whilst the other tried to induce expiration (see' From a Seat in the Audience '). This is exactly what might take place in natural respiration were it not for the existence of some co-ordinating power to control the various muscles involved. This controlling power, known as the respiratory centre, consists of a group of cells forming part of the C.N.S. (central nervous system) and is believed to lie near the junction of the cerebellum with the spinal cord, immediately below the pons. Impulses are sent out from this nervous centre along the vagus nerve to the larynx and lungs, along the phrenic to the diaphragm and pleurae, along the intercostal nerves to the intercostal muscles and along the cervical nerves to the muscles of the neck, all of which muscles contribute to the work of respiration. Perhaps there are few parts of the central nervous system which exhibit more sensitivity to external influences than the respiratory centre, but it is particularly sensitive to (a) carbon dioxide, (b) oxygen, (c) nervous impulses from the peripheral nerves and (d) temperature. We will examine each of these factors in turn. An excess of carbon dioxide in the blood supplied to the respiratory centre (and it will be appreciated that the cells of this centre require to be supplied with nutriment like any other tissues) has the effect of stimulating it to increased effort, with the result that the rate at which it ~ends out its impulses is also Increased, thus causing the respiratory movements to be quicker. Take a sharp run down the road and back again and you will find that

you are panting" for breath. What has happened? The increased muscular activity has produced an excess of carbon dioxide, and this has been carried in the bloodstream to the respiratory centre, stimulating it, and by reflex action has increased the rate of breathing so that the oxygen, which has been expended as a result of the extra muscular activity, would be more quickly replaced. Here, again, is another example of that biological law I referred to in our last issue, which enables nature to compensate for any disturbance in her regular working. It was stated above that the respiratory centre is sensitive to the amount of oxygen in the blood, but perhaps it would be more correct to explain that in this case the sensitivity is rather more indirect than direct. When, for any reason, as, for instance, the presence of an asphyxiating gas in the inspired air, the alveolar air contains less than a certain percentage of oxygen, the effect is felt by the respiratory centre, although this does not directly provide an extra stimulus, It does, however, render the respiratory centre more sensitive to the stimulus of the carbon dioxide, which then excites it to increased action as previously described. The application of pain or other stimuli to the surface of the body will cause a gasp, which is nothing more than a sudden, if momentary, cessation of respiration. It is the result of impulses which have been conveyed to the respiratory centre from the peripheral nerve endings on the surface of the body. Lastly, there is the effect of temperature. No nerve cells can operate perfectly if cold, a fact I will refer to later when discussing the question of artificial respiration. When we expire, do we empty the lungs entirely ? No, not even when, by bringing into play the abdominal muscles, we make an extra forced expiration, for there is always some air left in the lungs. In ordinary quiet breathing we inspire about 500 C.c. of air, expiring the same

amount. This is known as tidal air, but there is still a total of 2 500 c.c. left, of which 1,500 c.c. ca~ be expelled by a forced expiration as described above, leaving 1,000 c.c. residual air still in the lungs, which cannot be expelled by any normal means. The air which was expelled by forceful expiration is called supplemental air. Now let us take an ordinary inspiration, but, after having done so, we find that we can, by a forced inspiration, take in still more air, although but a limited volume. This is known as complemental air, and is about 1,500 c.c. Expressed in tabular form it would appear thus :Complemental air (by forced inspiration) 1,500 c.c. Tidal air (normal respir500 c.c. ation) ... Supplemental air (by forced expiration) 1,500 C.c. Residual air (permanently remaining in the lungs) 1,000 c.c. The above figures are, of course, approximate, and represent the average, as they vary in different individuals. NOTE.-1 ,000 cubic centimetres, or 1 litre, equal, roughly, I! pints. To discuss the respecti ve merits of the various methods of performing artificial respiration-and there are many-would be outside the scope of this article, but I trust that I have described the respiratory system sufficiently to enable first-aiders to carry out this operation with more understanding. Artificial respiration is not a matter of simply pumping air in and out of the lungs. This in itself would serve no useful purpose. It must be fully appreciated that the object of inhaling air is to extract from it the oxygen which must be carried by means of the bloodstream to every part of the body to nourish the tissues, including the heart muscle and the cells of the respiratoy centre. If these facts are kept in mind artificial respiration will cease to be merely a mechanical drill but will become a skilled operation carried out with meticulous regard to technical detail. Above all things bear in mind the importance of keeping · warm the cells of the respiratory centre. This can be achieved by saddling a hot-water bottle over the back of the neck, but it should only be partly filled to reduce its weight. Do, however,

make certain that there are two or three thicknesses of blanket or flannel between the hot-water bottle and the surface of the neck. Perhaps I cannot do better than conclude this article by answering some questions, one or more of which are always asked at the end of any lecture on Respiration. Cough.-This is a wonderful provision of nature for keeping clear the bronchial channels, and is the result of a respiratory reflex. It is stimulated in the first place by irritation of the surfaces of the mucous membranes of the pharynx and upper end of the trachea by particles of dust or other foreign bodies. The afferent (towards the brain) impulses from the nerve endings are conveyed to the respiratory centre along the superior laryngeal nerve, and the efferent (from the brain) impulses travel back via the vagus. Following an inspiration the glottis is tightly closed, and expiration commences. The intrathoracic pressure then increases until the glottis is no longer capable of repressing it, when it suddenly gives way, like the cork fr~m a child's pop-gun, and the imprisoned air escapes explosively, carrying with it the foreign bodies which caused the initial irritation. Note the value of cough and its varieties in diagnosis.

Sneeze.-Here we have a phenomenon of a similar nature, being a strong and sudden forced expiration, but through the nose instead of through the mouth. In this case the irritation is to the mucous membranes of the nasal cavities, and is transmitted to the respiratory centre along the trigeminal, or fifth cranial, nerve. It can, also, be stimulated by irritation of the external surface of. the nose. The glottis remains open, but the tongue is raised and pressed against the soft palate, and the pillars of the fauces are contracted, thus diverting the current of air through the nasal passages instead of through the mouth. Hiccough.-This is the result of a sudden reflex contraction of the diaphragm which causes a sudden inspiration. It is caused by irritation of the nerve endings on the surface of the mucous membrane of the stomach. Air suddenly forced

FIRST AID & NURSING, JULY/AUGUST 1954

~OMPETITION REPORT By F . C. R eeve IF all competitors in the St. John

Ambulance Brigade throughout the country were to be asked' What is your greatest ambition ?' the immediate reply would be ' To reach the Final of the Dewar or the Perrott' respectively. On Saturday, 19th June last, at the Central Hall, Westminster, twenty-four teams succeeded in realizing this ambition, twelve men's and twelve women's, and the struggles for these famous trophies proved to be keenly contested. The teams were :Men: Hetton-le-Hole, Broughton, Wolverton, Shrewsbury, Brecon, East Belfast, Mansfield Colliery, Markham Main, British Railways (Camden), Letchworth, Brighton Police, Exeter City Police. Women,' Atherton, Beccles, Cosham, Belfast Post Office, Harrogate, Brighton, Exmouth, Caersws, Moseley 'A', Middlesborough Central, Clapham Common, Spalding. The large army of judges and referees who had kindly givCl} their services was very gratifying, they being Area Commissioner J. Prentice, M.B., Ch.B., J.P.; G. Pari Huws, M.B., Ch.B., Area Commissioner r. Mackenzie, M.B., B.S., M.R.e.S., L.R.e.P.; Area Surgeon A. Conn, L.R.e.P. (E), L.R.F.P.S. (Glas.); Divisional Surgeon 1. Fletcher, M.R.e.S., L.R.C.P. ; County Nursing Officer Miss N. Livesey, S.R.N. (Matron) ; County Nursing Officer Mrs. Bayley, S.R.N.; County Nursing Officer Mrs. Nicholls, S.R.N.; Area Supt. F. W. Worker; County Sergt. Major S. R. Carter, B.E.M. ; County Supt. (Nursing) Miss D . 1. Hubbard, M.B.E.; Deputy District Supt. (Nursing) Mrs. Matthews. Referees: Maj. A. e. White Knox, O.B.E., M.C., M.B., Ch.B., Surgeon-inChief and Dr. M. M. Scott, Deputy Surgeon -in-Chief.

through the unprepared aperture of the glottis causes the vibration of the vocal cords, giving rise to the characteristic sound which accompanies the hiccough. Sigh.-When from any cause the circulation of the blood has been slowed down it is sometimes accelerated by a prolonged inspiration, produced by the abdominal muscles, and followed immediately by a sudden expiration, the result of the recoil of the lungs and of the muscles of the chest. This phenomenon is known as a sigh, and it has the effect of forcing into the right auricle extra blood from · the veins, thus improving the cerebral circulation. It is frequently observed in patients under general anaesthetic. Yawning is a very similar phenomenon.

Once again an interesting set of tests had been framed, comprising injuries selected from all parts of the text-books, and calculated to prove to the fullest the capabilities of the contestants. In the ambulance team test the members were called to a locked garage inside which the engine of a car could be heard running and a man was heard groaning. The garage door had to be broken open, and, after the victim had been dragged into the fresh air the injuries were found to be, in addition to asphyxia from CO poisoning, fracture of left arm, wound of right calf, with foreign body embedded, haemorrhage and (later) shock. In the nursing team test the members were called upon to deal with a boy who had fallen from a wall, and had sustained a wound of the left forearm with splinter of wood firmly embedded, simple fracture of left patella and grit adherent to right eyeball. There was, also, shock. In the individual and dual tests the men's leader had to treat a graze wound, with slight surrounding bruise area, very slight bleeding, fracture of right knee-cap and concussion. Nos. 2 and 3 were asked to deal with major epilepsy (subsidiary), simple fracture of both legs, and shock. The problem for NO.4 was carbolic acid poisoning and shock, with gradual swelling of the tissues of the throat and finally unconsciousness. In the nursing section the leader had to improvise a steam tent for an old lady suffering with acute bronchitis, make her comfortable in bed and carry out all necessary arrangements. Sisters Nos. 2 and 3 were asked to attend an old lady who was partially paralysed, incontinent and confined to bed. They had to tidy the bed and change the undersheet. Sister No . 4 was required to lay up trays for hypodermic injection and fomentation, give the injection and describe the technique of applying the fomentation . The Competitions were under the direction of Lt. General Sir Otto Lund, K.e.B., D.S.O. (Commissioner-in-Chief), assisted by Mrs. B. Grosvenor, e.B.E. (Deputy Superintendent-in-Chief), Maj. A. e. White Knox, O .B.E., M.e., M.B., Ch.B. (Surgeon-in-Chief) and Dr. M. M. Scott (Deputy Surgeon-in-Chief). The tests were watched by a large and interested audience, and it was very gratifying to note the presence of a number of principal officials of the British Red Cross Society, amongst whom I noted Dame Beryl Oliver, O.B.E., R.R.e., Air 'Commodore H. A. Hewat, e.B.E., M.B., Ch.B., D.T.M., and H., Mrs. O. S. Prentice, O.B.E., A.R.R.e. and Miss Hetherington, M.B.E. Would that we could see more mixing of the uniforms of these two great organizations, not only at top levels but amongst the rank and file. At 3 o'clock H .R.H. The Duchess of Gloucester, C.I., G.C.V.O., G.B.E., Dame Grand Cross Order of St. John, Deputy Commandant-in-Chief, The St. John Ambulance Brigade, arrived, and was received at the entrance by Sir Henry Pownall, K.e.B., K.B.E., D.S.O., M.e., Chancellor of the Order of St. John, who presented Sir Otto

FIRST AID & NURSING, JULY/AUGUST 1954

Dewar & Per rot Shields Lund Commissioner-in-Chief, The St. John Amb~lance Brigade. After inspecting the guard of honour, which was formed by the men and nurses of the competing teams, H.R.H. proceeded to the hall, where the winning nursing team gave an exhibition display consisting of the test which had been set them earlier in the day. The members of the team were then presented to her. Passing to another hall the winning men's team also gave a display of the test with which they had succeeded in winning top place, and the members of this te3J!l were also presented to H.R.H. After thIS H. R.B. was conducted to the platform in the Great Hall , where the Presentation Ceremony was presided over by Sir Henry Pownall, Chancellor of the Order. Sir Otto Lund was the first speaker after the chairman had explained that, owing to another important engagement, H.R.H. would be compelled to curtail her speech, and would have to leave much earlier than she had anticipated. Sir Otto said that they very much appreciated her visit to them that afternoon, especially as she had a very busy day to get through. Here followed the announcement of the results :Ambulance (Maximum marks possible 400) Marks Wolverton (Bucks) .. , 329t (winning the Dewar Shield, awarded to the team gaining highest aggregate marks in all sections of the Competitions, and, also the Trimble Shield, awarded to the te~ gaining highest marks i? the Individual section of the CompetItlOns.) Brighton Police 328 (winning the Symons Eccles Challenge Cup awarded to the team gaining second aggregate marks in all sections .of the Competitions, and, also, the HlO~s~on Rose Bowl, awarded to the team galOmg the highest marks in the Team Test section of the Competitions.) .. . .. . 31 n Exeter City Police .. . (winning the Hong Kong Shield, awarded to the team gaining third aggregate marks in all sections of the Competitions.) .. . .. . .. . 3 lOt Brecon (winning the Ellis Challenge Cup, awarded to team leader gaining highest marks in the Individual section of the Competitions. 30n· East Belfast .. . Shrewsbury 309 Markham Main 308 ... ... ... 307 Broughton British Railways (Camden) ... 306t Mansfield Colliery 282t Hetton-le-Hole 278 25n Letchworth...... The Copland-Griffiths Cup for smartest unifonn was won by British Railways (Camden).

Nursing (Maximum marks possible 400) Marks Brighton ... ... ... ... ~12t (winning the Perrott Challenge ShJeld, awarded to the team gaining highest aggregate marks in all sections of the

Competitions; the Ellis Challenge Cup, awarded to team leader gaining highest marks in the Individual section of the Competitions, and the Marguerette Golding Trophy, awarded to team gaining highest marks in the Home Nursing Individual Practical section of the Competitions.) Moseley 'A' ...

...

310~·

(winning the Corbett Fletcher Shield, awarded to the team gaining second highest aggregate marks in all sections of the Competitions ; the Chalmers Shield, awarded to team gaining highest marks in the Individual section of the Competitions, and the Lady Mountgarret Cup, awarded to the team gaining highest marks in bed-making section of the Competitions.) Clapham Common ...

302

(winning the Stewart Cup, awarded to the team gaining third highest aggregate marks in all sections of the Competitions ; the Mountbatten Trophy, awarded to the team gaining highest marks in the Team Test section of the Competitions, and tied with Harrogate ~nd Spalding for the Grosvenor Cup for smartest uniform (see below).) Spalding Caersws Harrogate Middlesbrough Central Beccles Atherton Exmouth Belfast Post Office Cosham

298 277ft

274t 269~

261 258 256 247 244

The Grosvenor Cup, awarded for the smartest uniform. Three nursing teams tied for this: Harrogate, Clapham Common and Spalding. In response to the invitation to present the trophies, Her Royal Highness said that she was glad to realize that the members of the St. John Ambulance Brigade were still keeping up their reputation , and partiCularly emphasized the example they must set the Cadets. 'These young people, I know, will find this example well worth following. To them we look to carry on the work. Since my last visit I note many improvements, and congratulate you upon ~he manner in which you carry out your duties. The need for first aid had always been a real one and this need still continues. She wished to encourage the members to go out and get others to join. She congratulated those who had merited the magnificent prizes which she saw before her on the table, and they had her best wishes. With a handshake and a kindly word for each competitor she then graciously presented the trophies to the winning teams. The comments of the judges were presented by Major White Knox, and proved most helpful. He stated that the judges felt that although the teams on the whole were gobd, they were in~lined to fail .to get the maximum informatlOn upon WhICh to base their diagnosis. The judges were also somewhat critical of the general treatment of haemorrhage.

Of the nursing tests the judges said that they would like to have seen more consideration shown to the patient. There had been a tendency on the part of some of the competitors to dash off to commence the mechanical part of the test before satisfying themselves about the comfort of the patient. In carrying out any treatment always prepare your tray properly before commencing. The familiarity with which this was carried out by members of the National Hospital Service Reserve was outstanding. In some cases there had been too much talking. 'You cannot talk and take a pulse at the same time.' In the case of the garage test the judges reminded competitors to hold their breath in the presence of CO gas. Any such person should be able to hold the breath for one minute provided they took a deep inspiration beforehand. They reminded competitors, also, that there was much more in artificial respiration than some seemed to think. They also emphasized a point which had been mentioned many times by judges : Don't take too much for granted. In the electrocution test the judge had purposely inverted the switch, and they should have made certain which was' on ' and which was , off.' On the whole the judges were delighted with the display of efficiency which, they estimated, was one degree higher than that of last year. Once again the Associated British Picture Corporation Ltd. were thanked for their generosity in supplying and erecting the scenery which contributed so much to the success of these events. A most successful event ended with three rousing cheers for H.R.H. The Duchess of Gloucester. Ministry of Supply Ambulance Finals On Friday, 25th June, the Central Hall was the scene of another important Final, that of the Ministry of Supply National First Aid Competitions (men and women) for the Challenge Trophies presented by the St. John Ambulance Association. Twelve men's teams and five women's teams had entered for these tests, and the keenness with which they were contested provided a difficult task for the judges who had undertaken to adjudicate. These were Dr. Gordon Gillies, of Burton-on-Trent, Dr. S. Margaret R . Thomson of Wanstead, Dr. E. Selby, of Ealing, who, .at the last moment, kindly agreed to deputIze for Dr. Mawson who was prevented from attendin~, and Dr. A. W. Gilks, of London. Ag~tn, the tests which had been set were of an mteresting and instructive nature. In the men.'s team test that electrocution problem agam turned up. The victim was f~)1:nd to be not only asphyxiated by electnclty, but had slight burns on the right palm, fr~ctures of both bones of right forearm, With bones protruding and a fracture of right femur. It had been' framed with a view to testing the observation of the team. Of the twelve teams competing only one managed to reach the' load ambulance' stage, and the judge, with whom I had a chat after~ards, agreed that perhaps a few more mlOutes might have been allowed. The women's team test had, also, been framed to test the observation of the members, for the victim should have been removed to avoid further danger. He was a decorator, engaged upon repairs, and had

FIRST AID & NURSING, JULY/AUGUST 1954

10 fallen through the roof, and was surrou~ded by debris from the ceiling, but, after a tIme, more lath and plaster fell from the h~le which had been made. He was suffermg from concussion which developed into compression, and had a lacerated wo~nd of the scalp and a fracture of the left thigh. In the men's dual practical Nos. 1 and 4 were called to an office where a girl clerk had put her hand through. a window, sustaining a laceration of the nght forearm above the wrist, exposing the bone, but with no fracture and a sprained right ankle. Nos. 2 and 3 find a cyclist in great pain lying across the handlebars of his machine. He has a dislocation of the right shoulder and simple fractures of seventh and eigth ribs on the right side. It is raining. In the women's dual practical Nos. 1 and 4 are called in next door to attend a man who had knocked his head in falling against the brickwork of the fireplace. He was concussed and had also sustained a compound fracture of the lower jaw on the right side. The test for Nos. 2 and 3 took us to a quiet road where they were asked to assist a man who had knocked over the tea-table containing a teapot and crockery. He had scalded his left leg and had also sustained a wound in the palm of his left hand which was bleeding profusely. In all the tests the tasks were made somewhat more difficult by limiting the amount of first-aid material available, thus testing the ability of the competitors to improvise. The organizers are to be congratulated upon having been able to crowd so much into the morning and afternoon, the whole programme being completed without a hitch. It is worthy of note that this is the fifth annual competition for men and the fourth for women, and both last year's winning teams (Glascoed, men, and Elstow, women) competed again this year. The reason for the absence of some of last year's competitors is that they are now under the Atomic Energy Department. At four o'clock all roads led to the Great Hall, where the Presentation Ceremony was to take place. ] t was presided over by Mr. Horace F. Parshall, T.D., M.A.(Oxon.), Director-General of the St. John Ambulance Association, who was supported by Mr. F. C. Musgrave, e.B., Deputy Permanent Secretary to the Ministry of Supply, Lt. Col. E. e. Croft, Deputy Director-General of the St. John Ambulance Association, Maj. A. C. White Knox, O.B.E., M.e., M.B., Ch.B., Principal Medical Officer, the judges and Lt. Col. J. E. F. Gueritz, M.A. (Oxon), Secretary and Mr. George E. Craft, Competition Secretary. Comments and criticisms from the judges, which are always regarded as so valuable, followed, and Dr. Gillies opened the ball. He felt that he must not be too critical, for the work had been well done, but the team work might be improved. Some carelessness was observed in the cases of some competitors in leaving dressings about. The teams were not too eager to remove the patient from the edge of the pavement, but he congratulated them upon the very accurate report usually given to the doctor. One team did rather more damage to clothing than was rendered necessary. He had been asked to say, on behalf of Dr. Selby, that he had noted with satisfaction the keenness and enthusiasm of all the (continued on page 11)

From a seat in the audience Some random & provocative comments on the competition S.J.A.B. Finals Teams strong on diagnosis were usually weak on treatment and vice versa. This has been noticeable at most of the first aid competitions I have reported during the past twelve months. Did the competitor who gave the housewife a long string of instructions expect her to remember them all ? Too much time is often wasted before commencing artificial respiration. Seconds may make the difference between life and death. Is not a fracture of the lower jaw usually compound? It was easy to distinguish between those who had taken the Royal Life Saving Society's course in artificial respiration and those who had not. Should a roller bandage be employed in first aid? Could not the competitor have found a more suitable place to park his bundle of blankets than on the abdomen of the patient? You cannot perform artificial respiration and talk at the same time. Bandages must not be allowed to touch the floor. Some teams engaged in too much discussion. Let the leader lead. The text-book says' hot tea.' Don't let it get cold before offering it to the patient. There is often too much 'fiddling' in blanketing stretcher. Why was artificial respiration applied to the patient who was obviously suffering only from concussion ? We would like to see cleaner hands. One pair was conspicuously dirty. Hot compress should be applied 'from chin to breastbone' not around the neck. In fractured patella limb should be raised BEFORE splinting, not afterwards. There is a definite reason for this. What is it ? More practice in bedmaking under expert supervision is indicated. It was easy to pick out those with hospital experiencesurely one good reason for enlisting in the N.H.S.R. When will nurses learn to tuck in with palms DOWN. Please do not smother the face of your patient with that top sheet. There is a correct technique for disposing of the surplus length. In one case of artificial respiration by two operators one was inducing inspiration whilst the other was inducing expiration. Clearly they had not learned the mechanism of respiration. In fractured patella the pad under the ankle must' raise the heel from the splint! It is useless to push in some padding as an afterthought. Before treating for shock indoors enquire as to the existing temperature of the room. Head and shoulders were not always lifted in treating fractured patella. This is important in helping to bring the fragments together. , Tidying beds.' There is a tendency to scamp this. Each sheet and blanket must receive individual attention.

Some enveloped corners were too large for neatness, and there was a lack of uniformity. ' Scrubbing up '-FIVE MINUTES, please. Why not ask the driver to assist with the lift instead of placing stretcher, especially if patient is heavy? A man is usually stronger than a woman. Insufficient use is made of Cheatle forceps. Often their true function is not fully appreciated. J am afraid there was air in more than one syringe. Fancy asking a male bystander' Can you blanket a stretcher? ' Don't tell the judge that you would take T.P.R. Do it. Ministry of Supply Finals After three minutes application of artificial respiration one operator suddenly wondered if there might be an obstruction in the throat. That fractured forearm was not always handled as gently as one might wish. Raising one end of the stretcher whilst another competitor charged at it struck me as an unique method of testing. Was it not fortunate that the house decorator fell upon a piece of carpet just the right size? Did not this m ake removal too easy? The systematic diagnosis of one team was certainly creditable, but other types of injury beside fractures should be sought. One iniured arm was moved in every possible ciirection before being palpated for fracture. A little water sprinkled on a piece of lint will not make a cold compress. One cannot help wondering why the feet of the man who had only concussion and a fractured jaw were bandaged together. The spectator who remarked' That bloke who writes in "First Aid and Nursing" told them not to wear stockings' little guessed that ' that bloke' was standing next to him. Too many questions are asked, the answers to which are obvious. Try observation first. Why was the sofa moved right under the hole from which debris was falling? Why place hot water bottles ON the chest and abdomen? Don't' maul' the patient in palpating for fracture. One leader took the operator off artificial respiration in order to send him to the telephone, but did not replace him. Leave everything as tidy as possible when you have finished. That regional anatomy again ! Where are the seventh and eighth ribs? It was obvious from the judges' tests that many bandages were too loosely applied, especially in the case of fractured femur. I saw more than one narrow-fold bandage used for the trunk. Does it take four bearers to blanket a stretcher? In the men's team test only one team reached the 'load ambulance' stage. Is is possible that the time had been cut too finely?

FIRST AID & NURSING, JULY/AUGUST 1954 competitors, but he gave this. sole~n warning: 'Don't jump to concluslOns ! Dr. Margaret Thomson followed, and commenced by saying that she would like to pat the women's teams on the back , for they appeared to know their text-books from cover to cover. However, I!-ot all t~e teams realized the danger of fallmg .debns from the ceiling, and, therefore, dId not move the patient in time. Diagnosis was good and, apparently, knowledge of treatment' also, ' but please put it into practice,' she added. Sometimes she thought that efficiency was apt to be sacrificed to speed, although the time allowed shoul~ have been sufficient to enable them to fintsh the test. The tension of bandages was not good enough, but the standard of w~rk generally was high. Some of the competItors washed their hands before handling dressings, but one in five dabbed their hands with some antiseptic cream. 'Soap and water are still the best,' she concluded. Dr. Gilks stressed the importance of correct treatment of burns. 'Be sure .you know how to deal with this type of casualty' he said. Before Mr. Musgrave was asked to present the trophies, Lt. Col. Croft, Deputy Director-General, announced the results :Men (Maximum possible marks 400) S. D. Elstow ... ... 299~ (win ning the Championship Trophy) . R. O. F. Bishopton ... ... ... 2901 W. D. C. Woolwich.. . 280~ R. A. E. Farnborough } tied 278t e. D. E. E. Porton ... 278t R. O. F. Glascoed 274t Headquarters, Chessington . .. 256 S. D . Rotherwas 248t R. O. F. Swynnerton 246t R. O. F. Chorley 231 R. O. F. Fazakerley ... 227 ~ S. D. Summerfield and Drakelow 207 R . O. F. Bishopton and S. D. Elstow tied for the best pairs Trophy (Nos. 1 and 4).

Women (Maximum possible marks 400) S. D. Elstow ... ... ... 309t (winning the Championship Trophy) . R. A. U. Hereford ... ... ... 293t Headquarters, Adelphi 279 .. . ... 249t R. O. F. Chorley A. R. E./ A. D . E. Fort Halstead 210 S. D . Elstow (Nos. 1 and 4) won the Best Pairs Trophy.

Mr. Musgrave said he felt it an honour to be asked by The St. John Ambulance Association to perform this service, which he regarded as a very pleasant duty. He would like however, to extend the thanks of all to Mr.' Duncan Sands, the Minister of Supply, and to The St. John Ambulance Association for the keen interest shown and the facilities which had been afforded. He wished, also, to pay a warm tribute to thos~ who hav:e trained in order to be of serVIce to theIr fellow creatures. He believed the teams had done exceptionally well, but, although it might be considered invidious to single out one particular team, he felt that he must mention the achievement of S. D. Elstow (women) who had now won the Tro~hy four times in sLiccession, a statement whlcll met with rousing cheers.

News· London Ambulance Service In 1953 the Accident Section of the London Ambulance Service dealt with 90,896 emergency calls-compared with 87,691 in 1952 and 87,012 in 1951. 39 ambulances were in commISSIon, operating from the 18 accident ambulance stations; they covered 457,514 miles, an increase of 15,246 over 1952. The average time taken to reach the scene of the calls was 7.8 minutes, and to reach street accidents the average time was 7 minutes. These compare with 8 minutes and 7.2 minutes in 1952. To reach the accident, attend the patient and arrive at hospital the average time was 20.8 minutes, compared with 21 minutes in 1952. Fridays and Saturdays are still the busiest days of the week, with averages of 267 and 266 calls, and Sunday remains the quietest day with ] 88 calls. St. John Cadets to Visit Malta A party of twenty St. John Ambulance Brigade Cadets, between the ages of 14 and 20 are to visit Malta as guests of the Brigade in Malta, from ]2th to 24th August. The history of Malta and that of the Order of St. John (parent-body of the Brigade), are so linked that the Cadets will find traces of their predecessors in works of mercy and of help to the suffering, wherever they go. Valetta itself was founded by the Knights of St. John in the 16th century and the great Co-Cathedral is a living monument to their deeds of valour during the 16th, 17th and 18th centuries in their fight to defend Christianity against the Turks. The Cadets were chosen by Ballot. Each County sent in the name of one Boy and one Girl Cadet the Cadets had to have either a Special Se~vice Shield or a Grand Prior Badge. The Special Service Shield is awarded to Cadets who have given over 200 hours of voluntary service, such as helping the Blind, in Nurseries, in Medical Depots etc. The Grand Prior Badge is awarded to Cadets who in addition to the First Aid and Home Nursing Examinations have passed in ten other proficiency subjects, such as Fire-fighting, Life-saving, Road Safety, etc. . The Cadets and their Officers will leave London Airport on 12th August and on arrival in Malta they will go to LUKA where the boys and their officers will either be under canvas or in barracks, and the girls and their officers will be at the Brigade Headq uarters. Countess Mountbatten, Superintendentin-Chief St. John Ambulance Brigade, is taking;' keen personal interest in the visit, and she and Earl Mountbatten will undoubtedly entertain the Cadets during their stay in Malta. The Cadets will be the guests of the Brigade in Malta for a week ~nd the? they will stay on another week paymg theIr own way. B.R. Western Region Mr. P. Anstey, Regional Ambulance Secretary, British Railways W~ster? RegIon First Aid Movement, has relmqUlshed the position on retirement, and is succeed~d by Mr. J. A. Martin, Assistant RegJOnal Secretary.

Mr. Anstey was Secretary of the Western Region District Ambulance Secretaries' Conference, was a member of the Standing Committee of Railway Ambulance Centre Representatives since its inception in 1945, and was appointed Chairman of the Committee in 1952. He was also a member of the Headquarters' Committee on First Aid Matters since its formation in 1948, and also served as a deputy member on the Association Committee of the Order of St. John from 1942. He was admitted to the Order of St. John of Jerusalem as a Serving Brother in 1942. Mr. J. A. Martin was Assistant Divisional Ambulance Secretary to the Chester Division from 1924 to 1929, when he became Divisional Secretary, and continued in that office until his appointment as Assistant Centre Ambulance Secretary in 1942, the post being re-designated .f\ssistant Regional Ambulance Secretary In 1948. He has been a member of the Standing Committee of Railway Ambulance Centre Representatives since its formation in 1945, and has acted as Secretary since 1952. Mr. Martin was awarded the Vellum Vote of Thanks of the Order of St. John of Jerusalem in 1939, and was admitted to the Order in the Grade of Serving Brother in 1943. London Transport Ambulance Centre The First Aid Competition for the Hally Tablet took place at Baker Street Station, on 24th and 25th June. This is a contest for the highest proficiency of marks amongst First Second and Third year members

resp~ctively.

The results were as follows :1st year Winner, Mrs. E. M. McMillan (Neasden); Runner-up, Mr. W. F. Stevenson (Clapham). 2nd year Winner, Miss A. M. Burrell (Broadway); Runner-up, Mr. J. Edwards (Clapham). 3rd year Winner, Mr. E. J. Talbott (Charlton Works); Runner-up, Mr. F. Mulholland (Dorking). The contest was judged by Branch and District Secretaries of the London Transport Ambulance Centre and was keenly contested. The Centre Secretary, Mr. S. W. ?arden congratulated the winners on their performances, particularly the winners of the Second and Third years, MISS A. ~. Burrell who had previously won the FIrSt year contest and Mr. E. J. Talbott .w~o now completed the 'hat-tri,?k' by wmnmg t~e First, Second and ThIrd year contest In consecutive years. Casualties Union (continued from page 3) 2nd SJ.A.B. Maidenhead 'A' tea~. St. A 1bans : 1st Industry, Butterwlck Research Laboratories. 2nd S.J.A.B . .11 8 Southgate. Stroud: 1st B.R.e.S. W~rw~ck / 21 2nd B.R.e.S. Gloucester 51. Bm1!mgha;11: 1st Industry N e.B. pes~ord Coll~ery. 2nd Industry N.e.B. WhItewick CollIery. Norwich: 1st B.R.C.S. Norfolk/16. 2nd Altrincliam: 1st B.R.e.S. Norfolk/98. Industry I.C.!. Winnington (H?lders): 2nd Industry I.e.I. Hyde. Darlll1gton. 1st Industry Hill Docks, 2nd Industry Dorman Long & Co., Ltd. Redcar. Newcast le-upon1st Industry .e.B.. Dawdon Tyne : Colliery, 'A' team. 2nd Police Northumberland County. Scotland: Bye Industry I.e.I. Glasgow. 1st S.J.A.B. Maidenhead Nursing.

FIRST AID & NURSING, JULY/AUGUST 1954

Answer

Beaders~

queries Answered by Dr. A. D. B~Iilios

Some of the reasons to which you refer are given in the more advanced first aid book; others are only to be found in medical text books. A book on 'Why' did in fact exist, but is now out of print. It may one day be reprinted, but we must always remember that our primary objective is to be efficient at first aid, and we cannot be expected to know everything. Incidentally, do we raise the head, shoulders and knees in a fractured pelvis ?

W. J. W. (Exeter) writes :I lVonder if you would be kind enough to answer a question for me. I am a male State Registered Nurse, in charge of a hospital ward, and I am also a. nursing officer in the St. John Ambulance Brigade. Would I be allowed, in an emergency, to give an intramuscular injection of Coramine or similar drug, while on duty with the St.lohnAmbulance Brigade. Occasionally while on public duty, I come across a case of collapse where a heart stimulant of this kind might be brought to good use. I always carry full equipment while on public duty and could easily include a syringe and Coramine. Answer I am afraid the answer from the

first aid point of view must definitely be NO. Before giving Corarnine, a provisional diagnosis of the cause of the collapse must be established and this is essentially a matter for a doctor. For some forms of collapse, Corarnine rnight do more harm than good. Sorry!

J. S. (Runcorn) writes :As an old first-aider I feel there is need of a book to satisfy the need of a keen enthusiast. By this I mean a book of 'Why.' In pursuing the b!ack book we are given causes, signs and treatment, but no mention of why we do these things such asplacing an unconscious patient in a dark room, why the tongue is furred in toxic shock, why the skin cold and clammy, why we raise the head, shoulders and legs in fractured pelvis if the patient requires it and many others. If there is such a book published I should like to know its title and where obtainable and price.

T. H. H. (Newark) writes :At the risfc of being called for a fool for the second time I am going to ask you this question, which was asked by a police officer at a first aid class. This police officer said that he had heard of a case where mercury was used in finding a body in water. The location of the body was known to be in a certain area in a flooded quarry, and a slice of bread was placed on the water with mercury poured on it. After a time the bread made a circular movement decreasing in the size of each circle. After a number of movements the bread made a bobbing movement similar to a fisherman's float. When the grabs were thrown in the body was found. The police offcer said it was not any use in trying to find a dog with it although a dog has a certain amount of mercury in the body. I asked the chemist at work about this query and he thought I was legpulling, after some thought he said that it might be the electricity in the human body, which was attracted to the mercury. Another theory was that the human body might have some metal in the pockets of the clothes. I would appreciate your remarks on this subject, I have learned through reading a letter of yours that there are more things happening in this world than we can really credit. Thank youfor help in the past.

FIRST AID & NURSING, JULY/AUGUST 1954

J. D. B. (Bournemouth) writes :In the last issue you referred to the rare danger of a patient having a second injection of A.T.S. Can you give me some idea of what the danger is ? Answer

The rare risk to which I referred is called Anaphylactic shock. It may occur within a few minutes of giving the injection and cause symptoms of alarming severity, namely shock, cyanosis, shortness of breath and an irregular pulse. In a patient suspected to be susceptible, the doctor will give a small test dose initially and if there is no reaction, give the major dose later. Should unpleasant symptoms develop, he can give immediately an injection of another drug called adrenilin which acts like an antidote.

J. L. S. (Brighton) writes :Recently I had an interesting case where a girl had been hit on the eye with a tennis racquet. Fortunately she closed her eye in time and there was no visible sign of injury but she complained that her sight had become blurred and I could see a reddish staining behind the pupil. I took no action except to advise her to see her doctor. Can you tell me of the probable cause of the condition ?

Answer

Answer She was probably suffering from haemorrhage within the anterior chamber of the eye (the part between the lens and the cornea). This may have arisen from tearing of the iris. (the coloured curtain around the pupil). But any blow on the eye may have serious consequences. Cases of this kind are often admitted to hospital for observation-hence some people would have improved on your first aid by referring her without delay direct to hospital and even by ambulance.

I would not dream of calling you a fool, but I must confess that I have never heard of the test. I have advised that your letter should be published in this column in the hope that another reader may know something about it, or may be able to make further enquiries, the result of which would be of interest to us all.

E. D. F. (Colchester) writes :Our doctor has criticized the recommended treatment for infantile convulsions in which the child is stripped, supported in a warm bath with cold compresses applied to its head. I should be very grateful for your opinion please.

W hen you receive a wound or

activities-and thus themselves slow down the process of healing.

burn, your body mobilizes its

'Furacin', however, is an entirely new type

repair squad to make good the damage. Infection by bacteria hinders the repair squad m its

of germicide, which destroys bacteria and prevents

work and may even overwhelm it, so that the wound

infection outstandingly well, and yet leaves the repair

heals slowly or not at all. So infection must be pre-

squad unharmed to get on with healing the wound.

vented or suppressed, and this some of the older

F or this reason, ' Furacin ' is becoming more and more widely used in hospitals and first-aid rooms in this

antiseptics do quite effectively. only the repair squad can do that. The drawback of

country and America. Made up as an ointment, it is easy to handle, and

the older antiseptics, such as acriflavine, tincture of

stable, and is available in a range of pack sizes to suit

iodine, etc., is that they interfere with the repair squad's

all users.

But no antiseptic, however efficient, will heal a wound;

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FIRST AID & NURSING, JULY/AUGUST 1954

* First-Aider~s Crossword No. 12

Readers' Queries Answer I too have doubts as to the value of this treatment. Infantile convulsions may be a sign of an ailment affecting the body as a whole; e.g., the onset of an infectious illness, but there are many other causes. My own advice in all these cases is to keep the child warm in bed, applying so far as necessary, the general principles of unconsciousness. There is no objection to coJd compresses to the head. The doctor will advise treatment according to the cause of the convulsions. Usually they will have ceased by the time he has been obtained, but they may of course recur.

FIRST AID & NURSING, JULY/AUGUST 1954

J. F. F. (Inverness) writes : A child aged 4 was brought to the first aid hut where I attend and both he and his mother declared that he had pushed a button up his nose and that it had not come down. I could find no sign of this and disbelieved the story but both parent and child were so persistent in their story that I advised the usualfirst aid and referred them to a hospital, explaining that an X-ray would settle the difficulty. The hospital accident doctor, however, did not take an X-ray but insisted that the patient should see a nose specialist. Can you explain please, why this case was so apparently difficult.

Answer A case of doubt like this often benefits from a specialist's opinion. The foreign body may be hidden behind one of the bones of the nose. ~ot all buttons show up in X-rays; It depends on their composition hence it would have been a good plan to have sent with the parent a similar button to the hospital for the experts to examine. Amongst the dangers of leaving a button up the nose, are inflammation and discharge from the organ and the risk of the button being inhaled into the air passages.

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(Solution next issue)

ACROSS 1. Fishy source of' A and D ' (7,3) 8. A patient may be allowed to do this as first stage of convalescence ... (3,2) 9. Cerebro-spinal fever .. . (10) (5) 10. Omits baskets (5) 12. Animal begins to hide in fear ... 16. Musical Gaiety ... (4) 17. Strong joints of smith and batsman (6) 18. Commonest compound fracture (5) 19 and 20. Raised in shock... (4,2, 3, 3) 21. Linen, sea, or whisky-and, of course, there's always the nurse ... (5) 23. First-aid training epithet (6) 24. Tess in confusion reduces the fracture (4) 25. From east to east the sun is hidden (5) 28. May have to be removed when treating a fracture of clavicle (5) 32. Exercise not to be neglected after most knee injuries ... (10) 33. Skin condition or straw from ... (5) one point of view 34. Under control and progressing (4,2,4) favourably SOLUTION TO CROSSWORD No. 11 ACROSS 5, Expel; 8, specialists; 9, siren 10, stethoscope; 11, X-rays; 12, ores 17, hypochondria; 20, cold compress 22, stye; 24, shelf; 29, exanthemata 30, alarm; 31, ultra violet; 32, nadir.

DOWN (4) 1. Often comes before nursing 2. Dressing material obtained from (4) splinter (5) 3. Firstly prohibit this instrument 4. Meat, suitable for invalid, is (5) mostly ripe (4) 5. Gives colour to the eye 6. Colourful disease of infancyIs there a blue one for boys ? (4, 7) 7. They return home after treat(3-8) ment (5,6) 11. River of life? ... 12. Often given by the doctor in (11) illness 13. Examined early in casualty when a fracture is suspected ... (3,4) (3) 14. True or false (7) 15. Cover in bandages from wet ash (3) 22. Cold part of poultice 26. No lad is knotty after a shake(5) up 27. Primary aim in fracture treat(5) ment (4) 29. Make well again (4) 30. Ears can produce these drugs .,. 31. Employed American editor in (4) brief... ... ... (Solution next issue) DOWN 1, Severe; 2, light; 3, blush; 4, Aston; 5, Essex; 6, pure air; 7, lungs; 8, systolic; 13, shed; 14, spoon; 15, scope; ]6, bones; 18, doss; 19, artefact; 21, leeward; 23, trails; 24, stain; 25, femur ; 26, fatty; 27, steam; 28, helix.

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FIRST AID & NURSING, JULY/AUGUST 1954

16 A New Topical Anaesthetic Menley & James, Limited, Coldha~bour Lane London, S.E.5, announce the lI1tr,?ducti~n of ' Quotane,' a topical ana~th.etlc for relieving the symptoms. of I~Ching, burning and pain, associated wIth leslOns of the skin. 'Quotane' belong~ to ~ woup of compounds (amino-alk?xYl.so~Uillolmes) which are unrelated to the came group. of topical anaesthetics. It has a lon.g~las!lDg effect, has a very low index of sens~t~zatlOn, and is remarkably safe. 'Quotane lS not a treatment, but is a valuable support. to the treatment of skin conditions that give the patient discomfort.. By re~uciog itching, it discourages scratchlJ1g, WhICh so often leads to secondary infection via the ~uperadded lesions. It has shown espeCIally good results in anogenitai pruritus. ' Quotan.e' is issued in 1 oz. (28g.) tubes. Trade pnce 42/9 per dozen; P.T. 10/8 per dozen; Retail price, including P.T. 5/ 8 per tube.

New Salt Tablets For furnace workers and others employed in high temperatures, Messrs. Cuxson, Gerrard & Co. Ltd., Oldbury, Birmingham, have recently introduced a new formula for their effervescent salt tablets. The tablets contain salt in an effervescent pleasantly flavoured base and 2 or 3 are quickly soluble in i -pint of water to produce a pleasant beverage in which the taste of salt is fully covered and may be take~ fre~ly and copiously. These tablets aSSIst m the prevention of the risk of' Fireman's cramp'

as the salt which is lost in perspiration from the body is replaced fr,?m the b~verage. They are available In contaIners of 500 tablets at 8/8d., plus postage. Durin~ the hot weather these are very much apprecIated by employees.

Miscellaneous Advertisements Advertisementswith remittance should be sent to First Aid & Nursing, 32 Finsbury Square, Lond~n, E.C.2. Rate 4d. per word, minimum 65. Box numbers 15. extra.

W'OUNDS AND THEIR TREATMENT (cont.from p. 3) assistant should arrange his digits in such a position that he can slide them into the correct situation directly his predecessor removes his hand. The short interval that elapses during the change-over is of advantage to the patient and corresponds to relaxing the constrictive bandage every twenty minutes. This interval is of importance since it allows blood to flow through other vessels for a short period and thus enables the tissues below the seat of injury to receive oxygen and nourishment which is necessary for them to preserve their vitality. The chief pressure points of the body will be described in a later article.

FIRST AID & NURSING, JULY/AUGUST 1954

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FIRST AID TO THE INJURED AND SICK Edited by A. P. GORHAM, M.B., Ch.B., M.R.C.S. Police Surgeon, City and County of Bristol

'FIRST AID' WALL DIAGRAMS 26 X 40 in. A-G Anatomy and physiology. H- J The triangular bandage. K, L The roller bandage. M. N Haemorrhage and wounds. 0, P Dislocations and fractures . Q, R Transport. S Artificial respiration.

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lar size. Ladies' white 'Vantella' shirts 34/6d. S.J.A.B. Badge Wall Shields 26/6d. STA.~. gold cased creasted Cuff Links 42 /-. Trophy Shields supplied. Medals and miniatures mounted promptly. Sew-on ribbon bars, 9d. per ribbon; pin-on ribbon brooches Is. per ribbon. Stamp for leaflets :-Montague Jeffery, Outfitter, St., GJles St Northampton.

Linen - 65. 6d., PO$t 4d. Paper - ls. 6d., post 4d. Set 0(19, on Roller:

UR New Series of competition papers based on 40th edition S.J.A.B. Book. Now Ready. Team Tests five for 5s. Individu a l Tests eight for 5s. Selby & Plowright, 135 Russell St., Kettering.

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Linen - 1265., post free. Paper - 63s., post Is. 10d.

ADAM, ROUILLY & CO.

The Britis h Red Cross Society have spec ially adopted a set of 6 sheets, A, D. M. N. 0, p. which can be supplied on linen with fittings for the special price of 405. post 8d.

Human Osteology, Anatomy, Etc. 18 FITZROY STREET, FITZROY SQUARE, LONDON, W.1 TELEPHONE: MUSEUM 2703

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A HANDBOOK OF

AIDS TO PRACTICAL HYGIENE

ELEMENTARY NURSING

Yvonne M. D. Cooper, B.Sc. and H. V. Davies, B.Sc. " ... An easily read, and easily underst?od? text~ook cover~ng such subjects as home planning, heat, li~htIllg, ~lr and ventilation, food and values. .. The book IS w~ll illus~rate~ and provides space for written answers to questlOn~ r~~sed III .the text ... The work is well worth the purchase pnce. (NurSing News.)

Arthur D. Belilios, M.B., B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N. This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. ~t With 192 pages and 124 illustrations 5s. describes in simple language the baSIC principles and procedures that under.lie TEACHERS' NOTES 25. 6d. the science of nursing, and contams I.--------....:~ brief descriptions of the more common diseases, with general notes on the BAILLIERE, TINDALL & COX DALE, REYNOLDS & CO. LTD. nursing required in each case. A c~m 7-8 Henrietta Street OR 31 Fin5bury Square plete chapter is devoted to the subject London WCl London ECl of home nursing, and the whole book provides for every first aider the ................ copy/ies of A Handbook of Elementary Nursing essentials of nursing in a handy yet Please send me { ................ copy/ies of Aids to Practical Hygiene comprehensive form. . I enc1ose remIttance . for which 0 f .. .......... ............ (Postage 6d• extra per volume.) With 314 pages and 57 drawings, 7s. 6d. Name ........ ......................... · ...... ·· .... ······ .. ···· .... ·· .. ·... -............................ ................. ........ ... ......... .. ..

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No. 702, Vol LIX

A coachbuilt ambulance on a Karrier chassis

are primarily caused by Staphylococci, Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms. SKIN

THIS newly designed ambulance has accommodation for 2 stretcher patients, and th e offside locker is convertible .t o accommodate four sitting patients facing forward. These seats are quickly removable before the carriage of an infectious case, th us rendering fu m igation of the interior a quick and simple operation.

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This ambulance is fitted with a wash basin, and tip-up attendant's seat.

SEPTEMBER/OCTOBER 1954

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Printed br HOWARD, JONES, ROBERTS & LEETE, Ltd., 26-28 Bury Street, St. Mary Axe, London, E.C.3, and published by the Propnetors, DALE, REYNOLDS & CO ., Ltd., at 32 Finsbury Square, London, E.C.2, to whom 3·11 communications should . be addressed.

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bactericidal thus obviating the need, when not convenient, of changing the dressings every day. FOR CUTS, ABRASIONS, BOILS and numerous skin infections, ANTI PEaL is unquestionably the remedy. It is already in widespread use by the medical and nursing professions in many parts of the world. ANTIPEOL is therefore

an essential component of e,'ery First Aid and Nursing Kit.

antipeo cutaneous ointment Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections ; OPHTHALMO-~NT1PE.OL for .ocular infections; DETENSYL for reducmg artenal tensIOn. MEDICO-BIOLOGICAL LABORATORIES LTD., CARGREEN RD.,SOUTH NORWOOD,S.E.25

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

GARROULD'S

First Aid

RAILWAYMEN RECEIVE AWARDS

for the

Regulation Uniform MEMBERS

Nursing

ST. JOHN AMBULANCE BRIGADE

September jOctober 1954

for

OFFICERS

THE photographs o n this page show

railway first-aiders of the NorthEastern R egion , British R a ilways receiving awards for efficient first aid . '

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D river G. T. Jennings, who is seen with Mrs. Jennings receiving a certificate of commendatio n from Mr. H. A. Short, Chief R egiona l Manager, was concerned with an episode last May, when his Fireman, M r. R . Re~p ath was holding a fire pricker when It sl ipped and one end came into contact wi th the live rail while he was still holding the other end. R edpath received a severe electric shock and was unab le to relax his hold on the pricker. o

In this Issue Railwaymen recent awards First aid in haemorrhage

Casualties unio n: Buxton T rophy

Notes on advanced physiology

First aid at the Zoo

St. George, or the D ragon ?

Readers' queries

First-aider's crossword ...

D river Jennings at once realised what had happened and he seized hold of R edpath in an attempt to pull him and the pricker out of contact with t~e li ve rail. Jennings,. however, on touchmg Redpath a lso recelved a severe electric shock which threw him clear of the man. Jenni ngs made another attempt to free R edpath and finally the circuit was broken. On R edpath being released he collapsed and fell off the engine and his body came to rest in the 6-ft. way between two live rails. Jennings, at great risk to himself, set about the difficult task of lifting R edpath clear of the lines without coming into contact with the live rails and he was successful in doing this.

"PORTLAND"

AMBULANCE GEAR

The UP AND DOWN action is quick and easy for loading or unloading. B. Shows t he top stretcher lowered read y for loading. C. Illustrates the same Gear wIth t h e top s tre~cher fra me hinged down for use when only one stretcher case is carried. D. Shows the same position as in •• C' on ly wit h cushions and b ack rest fitt ed for conv aleseent cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE. and the same advantages apply as described above. fu ll catalogue c( Ambu lance Equipment No.7 A will be sent on request.

,---------------

' Phone I WELbeck 0071 (Late GREAT PORTLAND STREET)

In the other photograph Mr. Short is making awards to Mr W . Holladay, P~ssenger Guard, IIkley, Mr. N . Smith, Slgn~lman, Beal, Mr. T. Robins, Millwright, Darlmgton North R oad and Mr. W. S. Atkinson, Driver, Starbeck Motive Power Depot.

Mr. R obins, who has spent 42 years in the first aid movement, rescued three-year old Susan Stainsby of Middleton St. George, from a flooded road excavation on 29th J uly. Whi lst passing in a car, he saw air bubbles and found the child under water. He applied artificial respiration and the child recovered.

A. Shows the two stretchers in posi tion .

65, WIGMORE STREET, LONDON, W.I

Redpath sustained severely burned hands and was given first aid treatment at the Station Ambulance Room, afterwards being taken to the Royal Yictoria Infinnary, Newcastle, where he received further medical treatment before being allowed to go home. Although Jennings also received a severe electric shock he was not off duty as a result of the incident.

Mr. Holladay gave first aid to his engine driver, whose legs were both fractured owing to a burst steam pipe as a train was running between Bradford and Ilkley, whilst Mr. Smith went to the aid of a salmon fisherman who had been run over and seriously injured by a tractor near Beal signal box.

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

Mr. and Mrs. Jennings with Mr. H. A. Short

P resenta tions to Messrs. W . Holladay, N. Smith , T. Robins and W. S. Atkinson

Mr. Atkinson was in the kitchen of his home when he heard an explosion and ran out to see flames coming from No . 6 Stockwel l Avenue, Knaresborough. He gave first aid to two injured people, 14-yearo ld Audrey Enunett who was suffering from shock and facia l burns and her father who was suffe ring from shock and abrasions. Though the girl was severely burnt Mr. Atkinson 's prompt action had prevented any disfigurement and the girl had made a splendid recovery. Mr. Atkinson has been in the first aid movement for nearly 30 years.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

A COURSE IN ELEMENTARY FIRST AID

• haemorrhage First Aid 10 By A. D. Belilios M.B., B.S. (Lond.), D.P.H. (Eng.) bleeding forms a big STOPPING subject in first aid. These articles are being written at the request of many readers who desired a series on pure first aid; hence no apology is offered for. sticking .to the subject. The last article comndered the general principles of pressure points and other methods of controlling bleeding; this month the more practical applications will be described. The first step is to learn the courses of the principal arteries of the body. They cannot, of course, be seen but they can be mapped out on the skin and sometimes, when teaching first aid, a lecturer will draw them on the body with lipstick or grease paint. The line drawn is called the surface marking of the artery. This month we shall consider the surface markings of the more important blood vessels and the sites at which pressure can be applied. Arteries of the Neck and Head The right and left common carotid arteries are derived from the arch of the aorta and leave the chest in the U-shaped notch at the top of the sternum. Each artery lies deeply in the neck just outside the trachea and upon the transverse processes of the cervical vertebrae. It divides into the external and internal carotid-arteries at the level of the upper border of the thyroid cartilage (Adam's apple). The external carotid continues the same course up the neck and divides into branches for the tongue, face, scalp and back of the neck. The internal carotid, however, runs more deeply and passes through a small opening in the base of the skull to assist in the blood supply to the brain. Pressure Point The recommended pressure point for the common carotid artery is in the lower part of the neck. Work from in front of the patient using the right hand for the left side of his body

and vice versa. Place the fingers at the back of the neck and the thumb accurately over the surface marking. By pressing the thumb backwards and slightly inwards, the pulse of the of the common carotid will be felt and the artery compressed against the transverse process of the 6th cervical vertebra. Use of this pressure point cuts off the whole of the blood supply of one side of the neck, face, head and brain. It can therefore be used to stop bleeding at any level from the sixth cervical vertebra upwards (except for cerebral haemorrhage), but it should only be employed in a serious emergency and for no longer time than is absolutely necessary, since it deprives the brain of its main blood supply. It is dangerouseven in practice-to press on both common carotid arteries at once, since this action may cause unconsciousness. In the serious emergency such as a deeply cut neck, when the pressure point has to be used, it may be necessary to press on both sides of the wound since the larger jugular vein is often injured at the same time as the artery. Some text books also describe pressure points for the facial, temporal and occipital arteries to stop bleeding on the face, scalp and and back of the head respectively. Their use is only occasionally necessary since direct pressure methods are generally successful when there is bleeding in these regions. But some authorities feel that advanced first-aiders should still learn these pressure points. Arteries of the upper limbs The main artery of each upper limb, called the subclavian, leaves the chest behind the j oint between the sternum and the clavicle where it lies deeply between the muscles attached to the latter bone, i.e., the outer border of the sterno-mastoid

and the front (anterior) border of the trapezius. The artery curves over the first rib and descends into the armpit where it is re-named the axillary and, after a short course, enters the inner side of the arm as the brachial artery. The brachial artery runs down the arm under the groove made by the inner border of the biceps muscle. When it reaches the front of the elbow, it divides into two branches, the radial and ulnar arteries, which pass down the forearm on their respective bones; ultimately they enter the hand which they supply with blood. Subclavian Pressure Point This is very important since its us~ cuts off the whole ofthe blood supply to the upper limb. Work from in front of the patient (who should be lying down) using the left hand for the right side of the body and vice versa. Place the fingers at the back of the neck and the thumb in the hollow above the collar bone just outside the outer border of the sterno-mastoid muscle. Incline the head towards the injured side and press inwards, downwards and backwards, thus compressing the artery against the first rib. Here the pulse will be felt and, in practical work, further confirmation that the flow of blood has been stopped obtained by feeling the pulse at the front of the wrist which will be found to cease as the pressure is applied. This pressure point may be difficult to find unless the student undertakes considerable practice which, of course, is essential in aU, branches of first aid. In an actual case, the first-aider may find it an advantage to place the thumb of his second hand over the first to reinforce his grip. Brachial pressure point Although the brachial artery can be compressed against the humerus at any part of its course, the usual

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

pressure point employed is at about the middle of the arm. Place the palm of the limb at the back of the arm, using the right hand for the left hand of the patient and vice versa . With the fingers, press the artery from behind along its surface marking, forwards and outwards against the humerus. Check that pressure is successful by feeling for the pulse at the wrist. The reason for working from behind forwards is that the artery curves forwards during its passage down the limb and the method recommended prevents it from being merely pushed backwards rather than compressed against the bone. Radial and Ulnar Pressure Points These are no longer recommended by the S.J.A.A. Nevertheless they are useful for controlling bleeding in the hand while a wound is being examined and equipment prepared. They are situated at the front of the wrist over their respective bones. The radial artery, of course, is that which is normally felt as the pulse; the ulnar artery cannot often be felt since it is generally covered by the tendon of a muscle. Arteries of the Lower Limb There is no need in this article to describe these in detail. The main artery is the common femoral and this enters the thigh at the middle of the groin. Its pressure point is of the greatest importance since the upper third of the vessel passes down the thigh not far from the surface of the skin and hence is easily severeda most serious accident. Finding the middle of the groin requires knowledge and practice. It is at the middle of the line drawn from the bony point at the front of the pelvis to the middle of the body at the pubic synphysis where there is another bony point. The first-aider should kneel beside the patient facing his feet and bend up his thigh to relax the muscles. With both hands he should grasp the patients' thigh so that his thumbs are on the pressure point, one over the other, to strengthen the grip. Pressure results in the artery being compressed against the brim of the pelvis. There are no other pressure points of practical value in the lower limb

except possibly for two at the front and inner side of the ankle the anterior and posterior tibial arteries respectively. They can be used temporarily to control bleeding from the foot. Special varieties of Bleeding Internal Organs. B1eeding may arise from internal organs such as the liver, spleen, stomach, lungs, etc. It may result from injury or disease. The bleeding may become visible or remain concealed. Thus, if from the lungs or stomach it will be coughed up or vomited respectively while if from the liver or spleen it almost certainly remains invisible since it cannot escape from the abdomen unless there is also a wound. The characteristics of concealed haemorrhage are the same as the general symptons of severe haemorrhage which were described in a former article and there is no need to repeat them. Since the treatment may require an urgent operation and blood transfusion, first aid is obviously that for shock with special emphasis on obtaining medical facilities as quickly as possible. Drinks and stimulants, however, must be withheld. Haematemesis. This refers to bleeding from the stomach usually caused by a gastric ulcer. After a varying period of symptoms suggestive of concealed haemorrhage, vomiting occurs. The vomit is dark red in colour, partially clotted and mixed with food; if the blood has remained in the stomach for any length of time before the vomiting takes place, it has often the appearance of coffee gr0l1l1ds. First aid is as described above. Haemopt),sis. Bleeding from the lungs, possibly caused by tuberculosis, is bright red in colour and frothy in appearance. It is coughed up and the patient himself will often express his opinion that it is coming from his lungs. First aid is as above except that the head and shoulders should be kept slightly raised and the patient's body inclined towards the Reaffected side if known. assurance and sympathy are of value as in aU cases of bleeding. Indeed many cases of haemoptysis can be told quite truthfully that the bleeding is no more serious than a nose-bleed.

Bleeding from the Rectum. If this is red in colour, it may be caused by injury e.g., a complication of a fractured pelvis, or a disease such as piles or cancer. This variety is not usually serious although in piles it may be profuse. First aid must be given for the causative condition and medical advice obtained. Even if cancer is the cause, medical treatment often provides a complete cure provided the patient goes to his doctor when the sign is first noticed. Malaena, is the term given to bleeding from the rectum originating from the upper part of the intestines-often a duodenal ulcer. The patient passes dark or almost black motions and the general characteristics of haemorrhage are present. First aid is as for haematemesis. Nose bleeding. The patient should be comfortable seated propped up in bed. His head should be inclined slightly forwards and the blood allowed to flow into a bowl. He should breathe through his mouth and warned not to blow his nose or to swallow, both of which actions disturb the blood clots. Cold compresses may be applied to the nose and all tight clothing must be undone. Should the bleeding persist, pressing the fleshy part of the nose against the nasal septum on the affected side may be successful, failing which a doctor must be sent for. Death from nose bleeding, although very uncommon, may occur if medical assistance is not obtained in bad cases. Other special varieties of bleeding e.g., from the socket of a tooth, varicose veins etc., must be left over for a subsequent article.

, Gray's Anatomy' 31st edition. Edited by T. B. Johnston, C.B.E., M.D., and J~ Whillis, M.D., M.S., Longmans, Green & Co. Ltd., price 100/-. This well-known book is now in its 31st edition, and its reputation is such that it is scarcely necessary to say more. Generations of medical students, one supposes, have blessed the book for its real authority and comprehensiveness. The price may be considered perhaps too high for the individual first-aider, but study circles and training groups may well decide that it is a real investment, and certainly its value will prove beyond mere £ s. d.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

How many readers are able to recall the early days of competition and the primitive attempts which were then made to achieve , realism,' when railway lines were represented by two chalk marks on the floor and half-a-dozen chairs served as a bus? , Injuries' were set out on cards attached to the 'casualties,' and the marking sheets were of a very general character. We have advanced far since those days and this advance is in no small measure due to the activities of the Casualties Union from whom, under the management of the General Secretary, Mr. P. G. Sargeant and his assistant, Miss W. A. Elston 'casualties' are receiving a very thorough training in acting, and 'faking' by the dressers has become a fine ~rt. On Sunday, 3rd October, on the occaSlOn of the twelfth Annual Competition of this organization staged at the Pinewood Film Studios, I ve~ Heath Bucks, by kind invitation of Mr. Arthu; J. Rank and his co-directors, the public had an opportunity of judging for themselves the valuable contribution to ambulance and nursing work now being made by the Union. A!though. announced ~s a ' Competition in FITSt Aid and Diagnosis '-with the emphasis on Diagnosis- it was, in fact a most valuable exhibition staged on a m~st elaborate scale. There were in addition to the Competitions, displays,' study circles, demonstratlOns and, above all information tables, where tr~ined attenda~ts were prepar:ed to explaIn thoroughly any points whicJ: may have been obscure, and to which enqUIrers were welcomed.

CASUALTIES UNION Report on the annual co'npetitions~ By These were judged by an army of doctors and first aid officers : First Aid : Dr. F. H. Taylor Streatham . Dr. C H. Hoskyn, London;' Dr. Ronald Mathews, Crawley; Dr. A. C Mackay, London; Dr. Jeane M. Scriven Farnham . Dr. R. S. ~arr Brown, London ; Dr. H. E.' Offord, Relgate; Dr. E. G. Huxley Cowan, London; .W. A. Sheen, London; C F. Blake, Bnxton; H. Marriott Enfield' C J. Morris, HatReld; S. V. Thompson: London; G. Bugden, Heston; S. W. Harden, London; C L. K. Dunn, London. Diagnosis: Dr. Ronald Piper Slough' D.r. ~. G. Brins Young, Lewes;' Dr. J. S: Brnnlllg, Harpenden ; Dr. J. C MacFadyen Stirling. Medical Advisors: Dr. J. E. Haine, Dr. J. H. Chambers, Dr. D. Towle.

The Teams

The Incident

. Twenty~five teams, ~in~ers of their respective RegIOnal Ellmmatmg Competitions had entered for this final contest. They were ~ Truro: 1. S.J.A.B. Redruth Nursing, 2. Sol .A.B. Redruth' A 'Team,

Each team consisted of six members and the contest w~s run in two parts, 4 of the members fomung a team to compete in the F.A. team test whilst the other two ha~dled an~ diagnosed the conditions of a senes of patIents.

Winchester: 3. B.R.CS., Andover, 4. Industry, S.E. Electricity Hants/5, Board, Mid-Sussex,

Co~petit.ion represented a series of accident~

Walfington: 5. S.J.A.B., 17 Wimbledon 6. B.R.CS., Cheam, Surrey/136. ' Putney: 7. S.J.A.B., 75 Southend 8 Industry, London Transport 'A' T~am: Reading: 9. S.J.A.B., Maidenhead Nursing, 10. S.J.A.B., Maidenhead' A ' Team. St. Albans: 11. Industry, Butterwick Research Laboratories Welwyn 12 S.J.A.B., 118 Southgate. ' , . Stroud: 13. B.R.CS., Warwick/21 14. B.R.CS., Gloucester/51. ' Birmingham:

Des~or~ Colli~ry,

Whltwlck Coillery.

15. Industry NCB 16. Industry, N.C.B:

Norwich: 17. B.R.CS., Norfolk/16 18. B.R.CS., Holt, Norfolk/74. ' .A/,:-incham.: 1.9. Industry, I.C.I. Alkali DlVlslOn, Wmmngton (holders), 20. Industry, I.C.I. Leathercloth Division, Hyde. Darlington: 21. S.J.A.B., Hull Docks 22. Industry, Dorman Long & Co., Redcar: Newcastle :. 23. Industry, N.CB., Rawdon Colliery, 24. Police, Northumberland County. Scotland: 25. Industry, I.C.!., St. Rollox ' G Iasgow.

The' incident' set as a test in the F.A

whIch rrught take place in the Pinewood or any other studios during the preparation of a set. BU!, ~ diabetic, having taken his usual Insulm ID the mo~ing before leaving ~ome, should take nounshment at a certain tIme, a~d had. arra.nged with Mary, the trolley gul to bnng him sandwiches from the canteen. Mary, in her haste following a del~y, collides with a heavy standard lamp WhICh falls upon John , who is on the ground p~eparmg to . erect a ' dummy' steel joist. BIll, meanwhile,. owirg t.o the delayed food, has coUapsed With Insulm shock behind the set, out of sight. Charlie (not a casualty) goes for help and sends for the ambulance He returns five minutes later. . Injuries other than those of Bill : John: Complicated fracture of pelvis, grazed cheek, lacerated thumb, Mary : Grazed leg. . The 18 casualties which had to be dJagnos.ed and handled by the two remaining c~m~etitors were fully described by Dr. BIllDIng at the end of the afternoon.

Displays . Whilst the competitions were in progress a !lumber of displays and tableaux were bemg staged in other parts of the Studios and not ~he least i~tere~tjng was the building marked study Circle. Here, presiding at

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

BUXTON TROPHY displays & demo"strations F. C. Reeve for the~r. i~spe~tion at close quarters, his or her. I~Jury, and at the same time Dr. J. S. BIDDIng explained the principal points

table~ .covered with grease paints, brushes, ~lastlclDe and ~ther modelling days, VaseIID~, dyes.' rabbit bones, splinters of wood,

nail varmsh and other impedimenta understood by fe:-v apart from these specialists, were the trarned dressers who gave practical demonstrations of the intricate art of , faking' casualties. It was interesting to note that many of these 'dressers' were from the Scottish contingent, and Mrs. A. L. Grant, the County Civil Defence Officer B.R ..CS.,. and her assistant, Miss S. T. W: AllOID, WIth whom I had a long chat, informed me .that the Casualties Union is very strong ID Scotland, especially in their own area, Glasgow. From here I passed to another building wher.e a ~ll1l?-ber of ' patients' represented SpecIal InjurIes and Conditions for first aid and nursing training outside the normal scope of competition work. Here could be studi~d the exact appearance of patients suffert~g from. erysipela~, small pox, ceramic ulcer, bOlls, frost-bite plastic sore wrist-drop, avulsed scalp, pI:essure burn: crushed hand etc. Not only had the appearance of the conditions been' faked' but the patients,' who had been well trained in acting, assumed the characteristic attitudes in which one would expect to see them. Dr. !'urn bul I was kept busy answering questlOns on the cases. Perhaps 'How NOT to' would be the best description of the next exhibition which, it m~st be emphasized, was staged fo; the educatIon, not of first-aiders but of members of the Casualties Union tr~ining to act as ' casualties.' The display had been stag,ed in the machine ~hop of the carpenters shop of the StudlOS, and at various machines were to be found 'casualties' who had met with various accidents. Instead however, of lying, sitting or standing in the charac.teristic positions. one would expect follo~lllg the respectIve accidents, they were III the WRONG positions, and it was for those of the spectators who were members of the Union who were trainees -:-~nd any first-aiders who cared to partICipate- to detect the errors. I will quote one example. The lady who had fallen and sustained a Colles' fracture was lying on the injured side, her weight supported by the flexed elbow on that side whereas the characteristic attitude shm;ld have been ~itt~ng with the arm supported by the unlDuJred hand. The educational value of such a series of tableaux cannot be overestimated.

Other demonstrations included one by the Visual Aid Team from the Depot and Training Establishment, R.A.M.C, Craokham, through the courtesy of the commandant, R.A ..M.C, Crookham, a display stand featunng all phases of the work of the Society for the Prevention of Royal Accidents, and a stand, staffed by Officers of the Institute of Civil Defence where full information concerning the ~ork of the Institute could be obtained. . Colour. was. lent to. the proceedings by SIX charrrung girl pages lD medieval costume v.:h~ mingled with the crowds inviting VISItors to purchase a copy of the Casualties Union Journal, truly excellent value for a shilling.

N H S R Display After tea there was more to come. An arena had been cleared in which further demonstrations and displays were to take place: First o.f all a 30 cwt. van appeared in the rmg beanng the Competition Team of the Windsor Hospital Management Committee's Mobile First Aid Unit (N.H.S.R.). t~gether with a complete outfit for establishing an emergency hospital. Before the eyes of a surprised audience out tunlbled a medical officer, a trained nurse and eight nursing auxiliaries of the N.H.S.R. and within minutes they saw a well-equipped emergency hospital established before their eyes. Tables, cupboards, packing cases co~taining ~rugs, instruments, bandages, splmts, dressmgs, heating apparatus sterilizer! st~etchers, chai.rs-everything, in fact, whIch It was at all lIkely might be required. Whilst this was being prepared, at the other end of the arena an ' incident' was being staged to represent an accident at a film st':ldio in which the director, wardrobe nustress and a stage hand were injured. An excellent demonstration of treatment then followed by members of the G.P.O. Savings Industrial C D. Team, after which the ' casualties' were carried across to the hospital where spectators were able to see what takes place when accident cases are received in casualty. Running commentaries on these displays by Drs. Lancelot Wills, of Wem~ley and J. C Blake, Physician Supe.rmtenden~, South Western Hospital, conSiderably mcreased their educational value. This display was followed by a parade of the 'cases' which had had to be diagnosed by the competitors earlier in the day, each in turn exhibiting to the spectators,

of each. The cases were Colles' fracture crushed finger (patient had fainted at sight of h~r own blood), delayed shock from burn t~nDls elb?w, 'stitch' (a common condi~ tI<;>n first-alders are often called upon to deal With on sports grounds), strained muscles of cal~, frac~ured ~umerus, fractured femur (paID ID hlp), anglDa (sudden pain resembles shock), sudden pain in eye (foreign body), fra~tur~d collar-bone, carbon-dioxide pOisonmg, fractured base of skull, diabetic c?ma (card m pocket, sugar in bag), fractured nb, compound fracture of tibia, sprained ankle and 'unconscious foreigner.' The last-named deserves special comment for although containing an element of hu~our' illustrates what might very probably take place, and, also, emphasizes the warning , Do not take too much for granted.' The' patient' really had nothing wrong with her, but had been discovered fast asleep. Wh~n awakened she began to speak in a fo~elgn tongue, which might have been rrustaken for delirium. In this demonstration, as in others, the' casualties' had heen trained to simulate the attitudes and reactions of the sufferers. By this time the judges had finished studying their marking sheets and had arrived at their verdicts, and a long table had been erected upon which were displayed the Trophies, and preparations for the Presentation had been completed. The chair was taken by the President of the Union Brig.-General Glyn Hughes, CB.E., D.S.O.: M.C, Q.H.P., who was supported by Ald. Charles Russell, C V.O., J.P., Deputy mayor of Westminster, and Mrs. Russell Mr. Gerald, a director of Pinewood Studio's and Mrs. Gerald, Maj.-General L. A. H~wes CB.E., D.S .O., M.C, of the British Red Cross Society, and others. The chairman commenced by saying that they had had a long day, and he did not propose to deliver a long speech. He had great pleasure in welcoming Ald. and Mrs. Russell and Mr. and Mrs. Gerald, all of whom had proved such good friends of the Union. Mrs. Russell and Mrs. Gerald were then presented with beautiful bouquets by one of the pages. Ald. Russell, said the President had always been conscious of the need fo; Civ~l D~fence in Westminster, especially dunng hIS year of office as Mayor of Westminster which included the Coronation. He wished to thank Mr. Gerald and his codirectors for their kind invitation to hold the Event at Pinewood Studios, and for the most valuable assistance which had been given by him and his colleagues. The President then announced the results of the Competitions, which were as follows :

5 First Aid. (Maximum marks 400) 1. Indus~ry. N.CB., Desford Colliery, 346, wmmng the First Aid Trophy 2. S.J.A.B., Hull Docks, 301. ' 3. Industry I.Cr. Alkali Division ,Winnington 278, (last year's holders) Diagnosis. (Maximum marks 340) 1. IJ.1dustry I.CI. ~k.ali Division, Winnmgton 235, wmnmg the Diagnosis Trophy. 2. S.J.A.B., Hull Docks, 218. 3. Industry N.CB., Rawdon Colliery, 207. Buxton Trophy. 1. S.J.A.B., Hull Docks, 519. 2. Industry I.e.!., Alkali Division Winnington,513. ' 3. Industry N.CB.,Whitwick Colliery, 511. Bef~re asking ;,\ld. ~ussell to present the TrophIes the PreSident mfonned his audience ~hat the Buxton Trophy had been presented In ] 949 by ~t. J. D. Buxton the first President of the Umon, for annual competition to be awarded to the team gaining the highest a~gregat~ of marks m both Diagnosis and Fust Aid. The First Aid Trophy was prese~ted b):' Mr. J. A. Tulk, in 1947 and the DIagnOSIS Trophy in 1947 by the President ~n~ Officers of the Casualties Union. Descnb~ng the work of the Union he emphaSIZed that its object was to pro~ote the study .and practice of Diagnosis Casualt);' ~ctmg and' faking.' Since the last CompetItlO!1s they had provided over 10,000 tramed 'casualties' covering no less than 1,000 events. In this way they had been enabled to assist the S.J.A.B., the S.J.A.A., the B.R.CS., S. Andrews A A Pol.ice, N.H.S.R., CD., R.A.M.C, R.A·.F:: Ra~ways, Industry, N.CB., Scouts and GUl~~S and many other organizations. Rlsmg .to present the Trophies, Ald. Russell SaId ~hat he felt sure that they would regret the CIrcumstances in which he had been asked to make the presentations for he was deputizing for Sir P~rker Morris, Ll.B., the Town Clerk and Civil Defence Controller designate to the City of Westminster, who had, unfort~nately, been taken ill. However, it gave him the greatest pleasure to undertake this task, for he was deeply interested in the work of the Union. 'We in Westminster' he said, 'havemade~uIl use of your Unio~, whose value we highly appreciate.' He felt that the highest credit was due to every ~ember, who gave time and study to this Important branch of the work without any thought of reward. It was all purely volun~ar~. Then, ~dst, deafening applause, he mVlted the wmners to come forward to receive the awards which they sojustly deserved. The proceedings were closed by Mr. E. C Claxton, M.B.E., who had been responsible for the excellent arrangements of the whole event, and who wished to thank, on behalf of the Union all those who had contributed to its sucdess. They were particularly grateful to Mr. J. Arthur R ank and his fellow directors for their generous hospitality and unstinted assistance and also to the members of their staff, to the doctors and first aid officers for judging the Contest, to the Royal Society for the Prevention of Accidents, to the Institute of Civil Defence, to the Commandant, R.A.M.C, Crookham, to A.D.M.S., London District, to the British Red Cross Society, to the St. John Ambulance Brigade, to the Boy Scouts and Girl Guides Associations, and to all others too numerous to mention.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

Notes on advanced physiology By F. C. Reeve F.Z.S., F.R.E.S.

THE NERVOUS SYSTEM MANY millions of years ago, when organic life was j list emerging from the inorganic, the first forms of animal life consisted of masses of simple undifferentiated protoplasm. No structural modifications enabled the various necessary functions like those of protection, ingestion, digestion, excretion, respiration, motion etc. to be performed by definite parts. These functions were all carried out by the protoplasm itself. It possessed a certain amount of irritability which enabled it to perceive the proximity of a particle of food material, round which it would wrap itself, extracting by some chemical process the required nutriment and then ejecting the unrequired waste by a process of unwrapping. The same irritability enabled it to perceive the approach of danger, when it would put forth projections of its substance to act as legs or fins (pseupodia) by means of which it would propel itself away from the threatening danger. The first step in the development (dare I use the word 'evolution' without touching off an explosion and becoming involved in heated controversy?) of animal forms was the appearance of a number of these cells united to form a single entity. ~uch a creature is to be found to-day In the form of Gonium, a body consisting of sixteen cells, each provided with two hairlike projections which, by lashing from side to side, enable the organism to be propelled through the water-for all these primitive animals were at first aquatic. Slightly higher in the animal scale is Volvox, consisting of many thousands of cells, but it would be impossible in an article of this nature to try to trace the everincreasing progress of animal life which eventually culminated in Man h~self. Suffice it to say that, whereas In the unicellular animals at the bottom of the scale, the protoplasm was able to perform all the functions necessary to the existenc~ of

the organism, this simple arrangement was insufficient to serve the purposes of those organisms which were becoming increasingly more complex. Groups of cells became specialized to perform certain definite tasks, and with specialization came, in many cases, modification. Special organs were developed to carry out the work of digestion, excretion, reproduction etc., but in order that these should work together in unison it was necessary that their respective functions should be coordinated. Further, it was necessary for the survival of the organism that it should be capable of receiving impressions from its environment which would be transmitted as impulses to all parts of the organism. Both these requirements were fulfilled by the development in certain groups of cells of a sensitivity which enabled them to receive impressions and transmit them as impUlses to other parts, thus correlating and controlling all other activities. Here, then, we see the beginnings of a mechanism by which the animal would be enabled to react to its environment. Certain cells near the surface, which were to become specialised for the reception of external stimuli, and known as sensory, or reception, cells, soon developed two filaments or fibres, one at each end, and known as processes. One extended to the surface of the animal, and was called the peripheral process, whilst the other, called the central process, passed into the interior. The whole unit, cell with its two processes, was known as a neurone. In the deeper tissues of the organism the central processes made contact with the processes of another set of neurones (connectors,) which formed an internal network, the point of contact being known as a synapse, and impulses received from the surface (which might be likened to electric currents) and transmitted to this internal network were then distributed by it throughout the body

of the animal. We now meet with a third type of neurone, one which, instead of receiving impulses, sends out active, or motor, impulses to certain muscles, stirring them into action according to the requirements of the animal. There are, therefore, three types of neurone forming what must be regarded as the primitive nervous system from which has developed (or' evolved ') the complex nervous system which we are about to study in Man himself. We cannot here study the detailed stages by which this development took place, for it must be realized that it took vast ages, far beyond human comprehension-geological time cannot be measured by any known human standards. We only know that it did do so, and that Man's present nervous system is the result. In Man there are two kinds of nervous reaction, conscious reaction which is under the control of the will, and unconscious, or automatic. For these two purposes separate types of nervous system must exist, and they are known respectively as the cerebro-spinal system and the autonomic system.

THE CEREBRO-SPINAL SYSTEM By means of this system the whole organism, Man, is enabled to react to changes in environment, such changes being perceived by the sensitive nerve-endings on the surface of the body. Pain, heat, cold, pressure and other sensations representchanges of environment which, if ignored, might result in serious consequences to the organism, and it is the mechanism which enables Man toreact to these stimuli that we propose to examine now. This mechanism has been likened to a telephone exchange, and it would be difficult to find a better example of the processes which take place than this classic one, which you have all found in your text-books. The brain has been compared with the exchange, and the

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

nerves issuing from it have been said to represent the lines carrying messages to and from it. We can now proceed to examine it in greater detail. The brain consists of a mass of nervous tissue occupying the greater part of the cavity enclosed by the bony skull, and is the seat of intellect and consciousness: It controls and co-ordinates all the activities of the body, and, for this purpose, is kept in communication, not only with its environment, but with all parts of the organism by means of the nerves which radiate in all directions. It is divided into two masses, the upper, and by far the larger, being called the cerebrum, and below this, at the back~ is the smal~er mass, the cerebellum, or lesser bram, the two being separated by a horizontal fissure (the tentorium cerebelli). The cerebrum is divided into two lobes, the right and left hemispheres, by the longitudinal fissur~ .il?- t~e middle line, although the dlvlslOn IS not complete as the two hemispheres are still connected at the base by a , bridge' consisting of a bundle of fibres (the corpus callosum). A section through the centre of the cerebrum discloses that the centre portion is white whilst the ou~er thickness (cortex) is grey, the whIte matter consisting of nerve fibres and the grey matter of nerve cells. It has been found by experiment that the greater the intellect or brain power the larger is the area of the. cortex. This area is, however consIderably increased by the cortex being thrown into folds (convolutions), presenting a crinkly appearance, and the greater the number of folds, the greater has been found to be the intellect. These folds are separated by fissures. Now it must be obvious that a delicate structure such as the brain will need protection, and this is provided by three coyerings kn~wn as the meninges. The mner covenng, the pia mater, which is in dir~ct contact with the surface of the bram, follows the indentations which form the folds, thereby lining, also, the fissures. The outer covering, the dura mater is a much tougher membrane a~d forms, also, the inside lining of the bony skull. ~t d?es, however, dip into the 10.ng1tud1l1al fissure as a lining, where It assumes the name of falx cerebri. Between these two coverings is the arachno.id, a thin, transparent membrane whlch

is separated from the pia mater by a shallow space filled with a thin fluid, the cerebro-spinal fluid, which acts as a cushion, minimizing any possible damage to the brain which might result from violent movement. The two lobes (hemispheres) of the cerebrum are not entirely solid, for within the centre of each is a cavity (ventrivle) filled with C.S.F. and acting as a reservoir to supply the arachnoid space. The anatomy of the cerebellum is similar to that of the cerebrum, consisting of grey and white matter, and being divided into two hemispheres, and the cortex thrown into fine convolutions. It is in the cerebellum that the tone, or tension of various muscles is regulated, enabling the equilibrium of the body to be maintained. The spinal cord is a continuation of the brain through the foramen magnum, but its upper end, adjoi~ng the cerebrum, has been modIfied to form two separate organs. The first, the pons Varolii, forms a communication between the two hemispheres of. the cereb~llum, which lies behind It, and conSists of both grey and white matter. Benea~h this is the medulla oblongata, conSISting, also, of grey and white matt~r, but, unlike the great organs above It, the white matter is now on the outside and the grey matter on the inside. Not only is the spinal c~rd . a continuation of the brain, but It stIll preserves a corresponding ~tructure, being protected on the outSide by. the meninges (now called the spmal meninges) and containing greJ:' .and white matter, although the pOSltlOns of these, as in the medulla oblongata, are now reversed. Now let us cut through the cord, exposing a secti~n as we did in the case of the bram itself and see what is disclosed. The 'grey matter, now forming the centre, presents the shape of thelet~er H with two of its legs (antenor h~rns) pointing forwards and .the other two (posterior horns) pomting backwards. From each of these horns springs a bundle of nerve fibres the two from the right side (right' anterior and posterior. ne~ve roots) joining to form the begmn1l1g of a nerve trunk which leaves the spinal canal by a foramen (hole) between two vertebrae, and the two from the left side (left anterior ~nd and posterior nerve roots) act1l1g

similarly. Although it has been stated that the nerve roots on each side join respectively, and are then enclosed by one sheath, they each continue to preserve their own respective functions. The posterior bundles, now forming part of a nerve trunk, are sensory, or 'afferent,' conveying sensory impulses from the surface to the brain, whereas the anterior ones, motor, or ' efferent,' convey impulses, which will stimulate certain parts into activity, from the brain. It must not be thought, however, that impulses travelling to the brain are received On the by it indiscriminately. contrary, we are now able to realize what a highly organized piece of mechanism it really is. Each sensory nerve, or group of nerves, tra vels to a particular area of the cortex, where the message is interpreted, and the appropriate response (motor impuls~) is then sent back via the motor nerves to act For instance, an accordingly. impulse received from the toes would be dealt with by an area of the cortex situated right on top of the head whilst an impulse from the eyes would be responded to from the back of the head. One curious fact must not be overlooked. In the medulla oblongata all nerves cross, so that impulses from the right side of the body travel to the left side of the cortex, and vice versa.

no you know that . . . 1. Opisthotonos (convulsions causing t~e arched body to rest on head and. h~e~s) IS a symptom of tetanus and menmgItis as well as of strychnine poisoning ? 2. Greasy dishwater. is ~n excellent emergency emetic-especlally if you let the patient know afterwards what he has drunk ? 3 The many-tailed bandage was devised by johann Scultet, a Gen;nan s.urg:on (15951645), and is known ill Amenca as a Scultetus bandage ? 4. A boil, or furun~Ie, us~all~ originates as an infection of a half foIltcle . 5. Penicillin is obtained from a m?~d! or parasitic vegetable fungus, called Pemclllium notatwn ? 6 GaU-stones consist, chiefly, of lime, bile'pigment, mucuS and phosphatic earths ?

FIRST AID & NURSING, SEPTEMBER /OCTOBER 1954

By a Special Correspondent

FIRST AID HOW many of the two million visitors who annually pass through the turnstiles at the entrances to the Gardens of the Zoological Society of London in Regents Park realize, when contemplating the care and attention bestowed by the Society upon the 5,000 odd animals, birds and reptiles (not counting fish and invertebrates) in its care, that the Society also has the welfare of its visitors equally at heart? This consideration, however, does not stop at providing for the needs of the inner man. Whenever vast crowds of people congregate together, as in the Gardens, it is inevitable that some casualties, both major and minor are bound to occur, a fact which the Society has not failed to recognize. Situated in a prominent position in the centre of the Elephant Walk is the First Aid Post, presided over by Divisional Officer J. A. Webb, D.C.M., of the Edmonton and Mill Hill Division, St. John Ambulance Brigade (he is also a Freeman of the City of London), and Nurse G. Locker, of the Harrow Nursing Division, St. John Ambulance Brigade. It was my privilege recently to visit this Post, where I was most courteously received by Divisional Officer Webb, and afterwards to see Mr. George R. Doubleday, the Society's Public Relations Officer, who, between them, furnished me with some most interesting information. The present building, I was told, was a gift, and superseded a tent which formerly served the purpose. The Post is well-equipped to deal with any emergency. Along one wall are two couches, curtained off for privacy, whilst on the other side is a long table upon which could be seen the drugs, lotions, dressings, bandages etc. laid out ready for immediate use. Hot water is always available, whilst hot water bottles, splints etc., were also in evidence. There were also a wheeled chair and a stretcher for bringing in unconscious or otherwise incapacitated patients from a distance. Is the Post justified? Well, a few figures supplied by Divisional Officer Webb and Mr. Doubleday speak for themselves. On average over 4,000 cases are dealt with during the year. Last Easter Monday alone Mr. Webb and his colleague treated 84 cases, although this number was exceeded on a day in 1950, when Brumas was attracting to the Gardens larger crowds than usual and 96 cases received attention at the Post: I asked Mr. Webb what type of injury appeared to be the most frequent, to which he replied tha~ of minor injuries, lacerated knees? br~lsed foreheads and cut lips, especIally 10 the cases of children were particularly common. Ladies often' came to the Post to have chafed heels, the result of il.l-fitting footwear, dressed, and a pec;ulIar type of burn was also prevalent. ThiS resulted from fathers lifting the children up to get a better view of the occupants of a cage and forgetting to remove the cigarettes from their mouths, often burning the faces or bare arms of the little ones. However, by no means all the casualties

AT THE

zoo

prove to be of a minor character. He recalled the occasion when one of the gardeners, to whom he had spoken a few seconds beforehand, dropped dead from heart failure outside the Post, a case in which of course, nothing could be done. On another occasion a boy fell into the panda pit, striking his head and sustaining severe cerebral concussion. On another occasion he was called upon to rescue a little girl who had fallen into the waders' pond with all her clothes 00. They had to send the clothes to the bakehouse to be dried. Pecks from parrots were a common occurrence, but bites from animals had considerably decreased since wire netting of a smaller mesh had been used to protect the public in most of the houses. Even then, he said, some children will persist in putting their fingers through tlus small mesh, especially in the monkey house. Another time one of the cook;s was brought in suffering from severe scalds to both arms. He had fallen with a large bowl of custard he had prepared for lunches in the Regent Cafe. Some idea of the number of major accidents dealt with in the course of the year may be gathered from the fact that over 100 cases had been sent to hospital since the beginning of the year (I paid my visit in mid-September). However, should medical attention be required, Dr. W. C. Osman Hill, pathologist to the Society, is always available. Tn 1948, two years after Mr. Webb was ~ppo.inted to the position, he suggested that, III VIew of the large number of nursing mothers he saw in the Gardens attending to their infants under very difficult and embarrassing conditions, an annexe be provided for their use, a suggestion which the Society lost no time in acting upon, and this annexe proved an irmnediate boon to mothers. Besides a good-sized table six specially designed nursing chairs have been provided, and Nurse Locker is always near to render any assistance which may be required. The work is not without its humorous side, and Mr. Webb chuckled as he related the story of being called out to collect a lost chlld. Arriving at the spot indicated, he found a little black boy sitting most co~te~tedly in a litter-bin, thorough ly enJoymg the sweets and fruits being freely supplied to him by an admiring and amused crowd. Incidentally, the collection and care of lost children is another most useful function of the First Aid Post, and I learned that it is not unusual for over 100 of these children to be brought to the Post in one day. It is very gratifying to note that there has never been a single case of a child being permanently lost. It was with feelings of keen admiration for the services of these two members of the Brigade that I left the First Aid Post in the Zoological Gardens, wishing D ivisional Officer Webb and his ass istant Nurse Locker, continued success in the 'valuable work they are doing.

FIRST AID & NURSING , SEPTEMBER /OCTOBER 1954

Treatment of Burns & Scalds In the event of a burn or scald, no attempt should be made to pul l the clothes off the skin. A doctor should be summoned at once; if the doctor is not inunediately available an ambulance should be called and the burn or scald described to explain the urgency. While waiting for the doctor (or ambulance) the patient should be kept warm and as comfortable and calm as possible and given a hot sweet drink. ]f the burn or scald is on a hand or foot or lower leg it may be held under the cold water tap to relieve the pain, and then covered with sterilized (or absolutely clean) linen or cotton. Nothing should be put on a burnt or scalded area except sterile (or absolutely clean) linen or cotton to cover it from the air, and whoever applies the material should wash their hands before so doing. Much original infection of such wounds is caused by dirty-handed first aiders. Every home should have a packet of sterilized linen or cotton material ready in a cupboard. To sterilize material wrap it in stout brown paper and bake it in the oven. A piece of white paper should be put in the oven at the same time and when this begins to turn brown, sterilization has been achieved. The brown paper packet should be put in a convenient, dry place, unopened unless an accident occurs. If no steri le linen or cotton is ready, clean laundered handkerchlefs, towels or pillow-cases, etc., may be used to cover burns or scalds. Besides burning and scalding, other serious home accidents occur from faUs, electric shocks, gas and other poisons, and suffocations. The Home Safety Department Royal Society for the Prevention of Accidents, Terminal House, Grosvenor Gardens, London, S.W.1, has some leaflets on precautions which can be taken. (From Ministry of Health, Advice Note 4/54 dated September 1954). Readers may like to know that a film calfed" Playing with Fire" (II minutes) made by the Central Office of Information for (he Ministry of Health in 1947 can be hired from the Central Film Library, Government Bllildings, Bromyard Avenue, Acton, London, W.3.

'Sports Inj ur ies Ma nual ' Donald F. Featherstone, M.C.S.P . Nicholas Kaye Ltd. 18/-. First-aiders will find much of interest and use in this book which deals especially with the type of injury received on the playing field or sports track. Back Numbers vVe receive many enquiries regarding back numbers of this journal, and for readers' information it is announced that there is a small stock of all issues published during the years 1951, 1952, 1953 and 1954. We regret that other years are now u nobtainable. Copies of the issues mentioned may be purchased from this office, price 5d. plus postage.

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burn, your body mobilizes its

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FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

St.

6eorge~

or the

ELE VEN years ago there was registered,

under the War Charities Act, a new first aid organization, the St. George Ambulance and Nursing Corps, in a littleknown Essex township known as Harold Wood. To local first-aiders it was considered as just a flash in the pan; a wartime exuberance resulting perhaps from bomb shock, which would pass as the shock wore off. Just ten members of Civil Defence, but ten men with new ideas on training and youth work generally, on organization, on examinations and quite certainly on enthusiasm. With the difficulties of war conditions, the last-named was exceedingly necessary and only enthusiasm carried this new Corps over its many hurdles. It still remains one of its outstanding features. For eight years it tried out its new ideas and innovations in about ten units closely packed into twenty square miles of Essex and learned by trial and error which t~ retain and which to keep. As a result the following alterations from the old ideas were decided upon and remains the basis of Corps policy : 1. ~lJ Units (juniors, cadets or seniors) are mIxed; both sexes being organized trained and officered without regard to se~ at all. 2. Org~nizati0f.l is based on army ~attern .W.'t~ SectIOns, Companies, Battal~ons~ DIYlslOns, etc., and county organizatJOn IS dIscounted. 3. Youth work should be studied and en~ouraged, and syllabus of training of a ulllvers l i and progressive character used. 4. Promotions must be based on ability only, no other factor is allowed to intrude. 5. The Corps must consider itself a teaching movement and all training is p.rogressive. For instance, pre-student nurslOg classes for prospective nurses are a feature. ? There must be no ' paper' membershIp; every member must be active or they are not a member. 7 .. ~oadside aidposts are out; modern condItIOns call for mobile posts which come to the casualty. Dual-purpose aid post-ambulance vehicle are to-day's need. 8. ~n officer must continue active; if enthUSIasm wanes, a successor is considered. 9. The~e should be always spirit and c0fl.lra~eshlp and to foster this, a positive socIal SIde. The Corps holds annual holiday camp, has bands and sports teams. 1Q. The Movement must remain democratl~ and the. Corps administrative Council consists of Directors controlling aspects of Corps work (i.e., nursing, training supplies bands, etc.), plus freely elected m~mbers of any rank. Three years ago it was decided to commence outsid~ the Es~ex County, and to-day the Corps JS establtshed in London K~nt, SUJ~rey, Sussex, Yorkshire and Lanca~ shIre, ".'Ih!Jst over half the rest of England Co.mmlssJoners have been appointed to ope~ unl~s. The Corps has a central ambulance statIOn at Worcester Park, Surrey; a stores

depot and several organizing officers in the Home Counties, but its general H.Q. is still in Harold Wood. In June the Corps becomes an International Movement with its first overseas branch in Bombay and in the same month one of its principal officers went to Northern Europe to commence work in the Continent. On 1st January, the Corps had 1,500 members and its policy (and the policy of every officer) is to close ] 954 wi th 15,000 members-a simple multiplication sum of 10. Several National Bodies (such as the A. A. , etc.), have agreed to accept the Corps certificates in parity with the older societies, and solicitors and counsel have the task in hand of final national registration. Like its Patron Saint, St. George is obviously set for all England Organization, but bow do the older first aid movements regard this new Organization? The Dragon?

NAP T Appeal HOLLY and. Candles-two very Christmassy thmgs- make the design this year for the one hundred million Christmas Seals to be sold on behalf of the National Association for the Prevention of Tuberculosis. It is an appropriate choice for holly }s gay and cheerful, and now~days there IS much to be cheerful about in the tremendous progress that has been made in the prevention and cure of tuberculosis. Candles, too, may symbolize the light of modern research which has achieved these splendid results. The work of the NAPT- which rcceives no government grant of any kind- is largely financed by the Christmas Seal Sale. The seals with their bright blues, grecn and gold are a gay little decoration for letters and parcels and only cost a hair-penny each or 4/- per sheet of 100. Thcre are Christmas cards to match at 8s. per dozen or in black and while with a coach and horses design at 4s. per dozen. The Seal Sale opens on 19th Octo.ber, 1954 and both seals and cards can be obta.lI1ed [rom the Duchess of Portland, Chairman NAPT, Tavistock House North, TavJstock Square, London, W.c./.

Progress of Blood Transfusion Service The Minister of Health, Mr.lain Macleod has recently made an appeal for mor~ blood donor~. He said that at the end of 1953 the natlOnal panel, with a strength of 5].5,900 donors, had passed the halfmIllion mark. This was a notable achievement a~d a cons~derable advance, but there was qUIte a Jot stdl to be done. !h~ appeal to donors is conflned to those enJoymg normal health between the ages of 18 and 65, and addressed in particular to the younger generation who alone can safeguard the future of the National Blood !rans!'usion Service. (People who have had J~u.ndlce should not volunteer, as this conditlOn may be passed on wilh their blood.)

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

CO~fPETITIONS AN International Ambulance Competition between British Railways teams representing England and Scotland was held in York on 14th September. Ten teams competed, five from each country, one team on each side being composed entirely of wo.men. England won by a margin of 16} pOints, the result being England J 843, Scotland 1826L The highest -marks of 396~ out of a total of 500 were gained .by Camden Good 'A' (London) team of the London Midland Region, Exmouth Junction (Southern Region) being second with 384~, but honour also went to the Scottish women's team from Glasgow which finished tbird with 37U marks. Other teams taking part to represent England were: Marks King's Cross M.P. Depot (Eastern Region) ... ... ... 370~ Shrewsbury (Western Region) ... 351 Hull women (North Ea tern Region) 340~ Marks for the Scottish men's teams were: Perth 'A' 374~ Motherwell 372 ~ Bridgeton 358 Eglington Street 343 ~ Judgcs were: Team Test: Dr. J. Prentice, Keighley. lndividual Test: Dr. W. W. Ballardie, Wetherby. Oral Test: Dr. J. Rodger Sutherland, Rutherglen . The competition was attended by Sir John Benstead (Deputy Chairman, Briti h Transport Commis ion) and Lady Benstead ; Mr. J. W. Stafford (Prc idcnt National Union of Railwaymen), and ma'ny railway officers and their wive . Mr. H.A.Short(ChiefRegional Manager, North Ea ' tern Region) presided. Thc Shield and certificates were prese nted by Mrs. Short. CORRECTION

Mr. F. C. Ree)le writes: I have becn a ked to correct one or two errors in my report of the Finals or the Competition between Mobile Pirst Aid Un.its, NaLional .Hospital Service Reserve, which appeared In the July/August number of First Aid amI Nllr.l'ill{J. I now underSland that ~redit for the detailed arrangeillents , plannll1g and control of operntions should h~v? ~one to Mr. BOLll·ton, of tile Hospitals DIVISIon of the Ministry or Health a lthou gh as Public Relations Officer, Mr. H~ald was a member of the organL-::ing committee, 1 learn, .also, that Miss J lornsby-Smith was unavoidably prevented from attending, and that the Lady with the Minister was Mrs. MacLeod. Major White-Knox and Mrs. Romer Lee were representing the St. John Ambulancc B~igacLe (not the Association). MI:s: Bryans IS Deputy Chairman of the Brlttsh Red Cross Society and the Perrnanent Secretary of the HOme Office i Sir Frank Newson. J offer my sinc~re apologies for any emba~Tassment whIch may have been o~caSlOned t1~oscconcerned, who, I rcel sure, WIll apprecmte that, despile the care exercised in trying to ensure that the sourccs of information arc authoriLative il is of~en .impossible to avoid inaccllra~ics creepIng 111.

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FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

W. L. S. (Liverpool) writes :-

Beaders~

queries Answered by Dr. A. D. B~dilios

D. J. C. (Taunton) writes :Several months ago a drug was mentioned which conveniently took the place of Benzedrine, havin¥ the same stimulath1g effects but without the disadvantages of Benzedrine. I would be obliged ~r you could give me the name of this drug. Answer I am suspicious of your question as it suggests that you may inte~d to exceed the limitations of first aid by giving it to a patient or using it personally. Such drugs sh~uld be administered only on the advice of a doctor. Actually there are several substitutes for Benzedrine, the latest being a combination of two remedies. But I am not going to tell you the name. Your own doctor will, of course, know. Sorry!

F. E. C. (Slough) writes :I work in the ambulance service and often have to move heart cases to Hospital. Are there any special rules in regard to their position during removal. Answer I believe that the doctor who requests the removal should be asked this question when he applies to the ambulance authorities since heart cases vary in their needs. If, for example, there is shortness of breath, blueness of the cheeks, finger nails, ears etc., the desirable position is almost sitting up, as near as possible to a cardiac bed. When, however, the patient is shocked as in coronary thrombosis, or is suffering from a heart complication as in rheumatic fever, transport recumbent is desirable with the head only slightly raised.

1 wonder if you would mind answering what may appear to be a very simple question namely why the face becomes livid in Epilepsy. I hesitate to ask but I have found Questions and Answers so useful in the past, that I would like to take advantage of your column. Answer

As a matter of fact your question is not quite so simple as you t~ink since several causes are actmg. First, of course, partial asphyxia is present owing to the temporary cessation and subsequent Irregularity of breathing. This prevents the free return of blood to the heart and causes a bluish colour (cyanosis) Secondly, the convulsions ~hemselv.es interfere with the capillary Clrculation to the skin which tend to cause it to become blanched. *

J. S. (Wembley) writes : As the first-aider in charge of the first aid room at our factory, I am often asked difficult questions. The latest is whether a mother who has never had mumps should be allowed to continue at work while her child is at home suffering from this illness. I said that it was not likely that the mother aged 47 would get mumps at her age but I should like your confirmation. Answer

You can catch mumps at any age. I heard of a case recently in a patient aged 70. Mumps may be infectious for a day or two before the first signs appear. If, therefore, your employee works near others who have not had mumps, she could cause quite a number of other cases with consequent loss of produc~ion hours quite apart from suffermg. This, however, is not a question that should be decided by you. The factory should take the advice of their work's doctor since it is a tricky problem. My own advice would be to ask her not to come to work between the 10th and 21st days after her child developed mumps but to pay her during her absence.

J. C. B. (Dublin) writes : OUf lecturer has disagreed with the treatment given on P. 180 of the S.l.A.A. Manual for a young child who has been severely burnt-namely putting it into a warm bath containing bicarbonate of s?da ?r saline and waiting for medlcal ald. Our lecturer recommends wrapping the child in a blanket and speedy removal to hospital. Would you mind stepping into the argument please? Answer I should hate to But surely the answer depends on the circumst.ances and environment of the aCCIdent. Usually doctors cannot be easily obtained particularly when they are out on their rounds. Hence in many cases I feel it is a good plan to dial 999 a~ld follow your lecturer's advice. I note, however, that you write frol? Ireland· in some parts of thIS country may be more easy to obtain a doctor quickly than to arrange for speedy removal to hospital and in· such cases the text book advice might well be the better.

FlRST AID & NURSING, SEPTEMBER/OCTOBER 1954

5 T. DUNSTAN'S CLOCK.

On the wall of St. Dunstanin-the West in Fleet Street, is the first clock showing

minutes ever to be made. It was also the first clock to

have two dials. It was made in 1671.

CLOCKWORK

REGULARITY

Normal bowel action is a fine thing to possess.

It is,

perhaps, the most sought after talisman against ill-health in the world.

No wonder, then, if its temporary sus-

pension leads from a mild despondency even to black despair.

But in such a crisis panic measures are to be

avoided-the taking of harsh purgatives eschewed. Success in the restoration of the much-cherished habit lies in the regubr

persuasiv~ stimulus of soft bulk-such as is provided by , PETROLAGA~.' Gently and unobtrusively, ' PETROLAGAR' arranges for normal phY.SlO~ logical evacuations and secures the return of 'clockwork regular_lt_y_.____________,

Answer I would follow the text book treatment with modifications. The bandages almost as usual but with one extra round the chest, so that both are arranged as for fractured ribs. I-would have a long splint on the right side but only a shorter one on the left, extending fromjust above the hips downwards, since obviously it would be undesirable to have a splint over the fractured ribs. Tie off the bandages over the right splint bearing in mind the rules for broken ribs including the sling.

Tnt.le Mark

JOHN WYETH & BROTHER LTD., Clifton House. Euston Road, N. W. I

EMULSION

N. B. D. (Leeds) writes :Recently in a competition, we were given the case of a man who had broken both thighs and also his ribs on the left side. Would you give us your opinion on the treatment which we should have adopted since we/ailed rather badly through applying the three splints recommended in the Authorised text book of the S.J.A.A.

'PETROLAGAR'

R. F. F. (Bournemouth) writes I remember when I was younger that styptics were used to stop bleeding. What was a styptic and why is it no longer z'~ed in .first aid. ?

HOUSEHOLD PHYSICIAN

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FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

READER'S QUERIES continued

Answer A styptic is a su bstance which stops bleeding by causing contraction of the blood vessels. Common styptics are only effective in minor cases of bleeding and for this reason are not used in first aid. The clotting of blood is nature's method of stopping bleeding and the dressings used in first aid encourage this. Moreover, direct pressure on a wound is more effective than a styptic.

E. O. D. (Belfast) writes :Judging from the papers, there is a lot of food poisoning about at the. moment. What is the correct procedure for this condition. Answer It is best to have a word with a doctor by telephone if necessarybefore giving treatment since the symptoms of food poisoning i.e. diarrhoea, vomiting and griping abdominal pain can be due to other causes e.g., gastro-enteritis caused by a germ. In recent years, new drugs have been brought out which will destroy the germs which are often the cause offood poisoning. Nevertheless, in an emergency, the treatment recommended is the S.J.A.A. book.

A friend of mine has recently had an operation and had an extra rib removed. She suffered from chronic pain in her arm and hand which she thought was due to frequent strain due to her work. Can you give me some information about this peculiar condition please ?

Answer y o~r friend almost certainly had what IS called a cervical rib-an extra rib in the neck arising from the 7th cervical vertebra. The rib is not ~ully developed and is often present m both sides. It is congenital. ~ymptoms and signs such as pain m the upper limb and wasting of muscles are caused by pressure on the brachial plexus of nerves in the neck which supply the upper limb.

* Fi,·st-Aider~s C,·ossword No. J3 Compiled by W. A. Potter

O.D.D.[].ODODODO DOOOOOOO.O.O.O. O.O.O.O.EJOOOOOO ~OOOOOOO.O.O.O. O.O.O.O.EJOOOOOO O••~EJOOOO.O.O. .EJOOO.O.O.EJOOOO .O.O.rJOOOO.O.O. EJOOOO.O.O.EJOOO. .O.O.EJOOOO.O••EJ EJOOOOOO.O.EJ.EJ.O .O.O.O.r:JOOOOOOO EJOOOOOO.O.O.O.O .o.o.o.rnoooooo ·LJOOOOOO.O.O.O.O

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

MEN~S

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for Divisions of the St. John Ambulance Brigade can be obtained from

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'Grams:

r----

ACROSS 5. Sound indication of difficult respiration ... .. . . .. (7) 9. Mischievous spirit played a type of 27... .. . ... ... (8) 10. Blood deficiency (7) 11. Ill-health ... ... .. . (8) 12. Office without authority . .. (7) 14. Abdominal organ from Sambo we lost '" ... .. . (5) 15. Helps to arrest Haemorrhage .. . (4) 16. Cold ... ... ... .. . (5) 17. Twist spine for a bird ... . .. (5) 18. Politician ends painful spasm of muscle ... ... ... (5) 19. Render insensible by blow on head. ... ... ... .. . (4) 20. Sounds of feline pleasure .. . (5) 22. Should be cut straight across .. . (3-4) 25. A pointer for Alkaloid drug .. . (8) 26. Convert... ... ... '" (3-4) 27. May be simple or depressed or 9 (8) 28. Structures made by half-a-score Professors (7)

DOWN I. Suet is body material ! ... (6) 2. Band~ge for thumb, shoulder, or grom ... ... ... (5) 3. Location, time and circumstances of occurrence (5) 4. Homely drachm ... (11) 6. No slit cut in the throat (6) 7. Unevenness (10) 8. Process by which e~~rgy is produced from foodstuffs in the body (9) 12. Increased by fever exercise, or its first part '.. . .. . (11) 13. Ubiq ui.tous malady caused by 24 (6-4) 15. POlsonmg where emetic is contra-indicated (9) 20. Rickety chest, or haif~an~~i bird... ... ... (6) 21. Odd number mostly even ... (6) 23. Vice adds nothing for this sound affair ... .. . .. . (5) 24. Micro-organism seen recently ... (5)

(Solution next issue)

SOLUTION TO CROSSWORD No. 12 ACROSS 1, Halibut oil; 8, sit up . 9 meningitis' to,. skips; 1.2,. cower; '16: glee; 17: wnsts; 18, t!bla; 19, and 20, foot of the bed; 21, Insh; 23. useful; 24, sets; 25, ensue; 28, brace; 32, quadriceps; 33, warts; 34, well in hand.

DOWN 1., .Home ; .2, li£?t; 3, banjo; 4, tripe; 5, lflS; 6, pink disease; 7, out patients; 11, blood stream; 12, certificate' 13 wet-film ~ 14, rib; .15, swathes; 22: ice; 26, nodal; 27, unlOn' 29 cure' 30 sera; 31, used. " , ,

LADIES~

"Hobson, Sedist, London"

Miscellaneous Advertisements - - - .

Advertisements with remittance should be sent to First Aid & Nursing, 32 Finsbury Square, Lond~n, E.C.2. Rate 4d. per word, minimum 65. Box numbers Is. extra.

SCENT CARDS, 250 17/6, 1,000 52/6. Tickets. Posters, Memos. SdIllples free-TICES, II Oakland.s Grove. London, W.12.

This comprehensive Catalogue, published by the Pioneers of Ind ustrial First Aid, includes a section summarising Official First Aid Regulations. It is available free to users of First Aid equipment who apply on their Company's letterhead, and refer to this publ icat;on.

CUXSON, GERRARD & Co. Ltd., OlDBURY, BIRMINGHAM. Phone: BROadwell 1355.

S J.A.B. Car Badges, 30s. S.l.A.B. Badge Wall Shields, 265. 6d. • SJ .A.B. Gold cased crested Cuff Links, 42s. S.l.A.B. Badge Ladies' Brooches, 15s. Trophy Shields supplied. White "Old England" shirts, 21s. 6d. ; Poplin quality, 30s. (state collar size). Medal ribbons 9d. each on buckram for sewing on uniforms, Is. each ribbon jf mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for leaflets.-Montague Jeffery, Outfitter, St. Giles Street, Northampton.

UR NEW SERIES of competition papers based on 40th edition ow ready. Team tests 5 for 5s. Individual tests 8 for 55. Selby & Plowright, 135 Russell Street, Kettering,

O S.J.A. B. book. Nortbants.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

BRITISH RAILWAYS AMBULANCE CENTRE (SOUTHERN REGION) AMBULANCE FINALS

3. 4. 5. 6. 7. 8.

Seldom has the Borough Polytechnic in South-east London presented scenes of greater activity than were to be witnessed on 23rd April when six of its spacious halls were engaged to stage the annual First Aid Finals of the British Railways Ambulance Centre, Southern Region. No less than 27 teams competed-9 men's, 9 women 's and 9 police-certain evidence of the enormous interest taken in this valuable subject by the railway fraternity. Results were : -

409

Southampton Docks Dorking' B ' Brighton ... Dorking 'A' Victoria ... London Bridge Waterloo ...

Police Team Test 1. Bricklayers' Arms (' Crowden' Cup) 2. Waterloo.. . .. . 3. Liverpool Street 'A' 4. Euston 5. Paddington ... 6. Liverpool Street ' B ' 7. Victoria 'A' 8. Victoria' B ' 9. King's Cross

386

348 347

33H

278 276t Marks

390 ...

379 375t

329 327 297

291 291

291

Men's Team Test Marks 1. Exmouth Junction M.P. No. 1 ... 479 } (Challenge Shield) 2. Brighton No.1 ... 473 t (Challenge Cup) 3. Horsham No. I 439 4. Southampton Docks S.M.E. No. I ... 409t 5. Twickenham 'A' 395 6. Eastleigh Station 38n 7. Redhill... ... ... 333t 8. Eastleigh Railway Works 326 9. Faversham 28st

Winners Semi-Final 1. Horsham No. Shield.

Women's Team Test 1. B.T.C. Policewomen 'A' (Challenge Bowl) 2. Eastleigh Accounts

Mr. H. R. Lang, Regional Staff Officer said he would like to thank the judges-~ grand lot of chaps. He sympathized with them in their thankless job, standing there all day with their marking sheets and

Marks 420~

420

Individual Practical 1. Exmouth Junction M.P. No. 1, Moore' Cup. All Line Final 1. Eastleigh Works-' Richards' Cup.

1-' Templeman'

keeping a sharp eye on every move of the competitors. They were Dr. J. MainRussell, of Sheffield (Men's Team Test), H. S. Taylor-Young, of Salisbury (Women's Team Test), Dr. J. R. Hamerton, of Westgate-on-Sea (Police Team Test), F. M. Hanna, F.R.C.S., of Weymouth (Individual Practical Tests, Men and Police), Dr. T. L. Scott, of Christ's Hospital (Individual Practical Tests, Men and Police), Dr. T. P. Howkins, of Eastleigh (Individual Practical Tests, Women), Dr. E. J. Selby, of Ealing, Dr. H. R. McAleenan, of Eastbourne, Messrs. H. Webb and H. Whyte, of London (Oral Tests for all teams). Dr. Taylor-Young commenced by saying it was part of a judge's task to look for errors and weaknesses. Referring to the Women's Team Test he had noted that no lady knew how to break a gun, but he felt sure that the opportunity of handling one presented a great temptation, for he knew they had all been waiting for an opportunity to shoot the judges! He noted, however, that they had all climbed the five-barred gate without tragedy. Dr. Hanna emphasized the problem which had been presented by an acid burn complicated by a severe wound of the hand. , Get rid of the acid as soon as possible,' he advised. He was afraid that there were some 'patients' still suffering from acid burns! As to the test as a whole, there had been no ' trickery' and no attempt to 'catch out' the competitors, 'but,' he added, 'the competitors must not try to " catch out" the judge.'

Aid for the Brigade by

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Tel: CLErkenwell 9274 (5 lines)

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FIRST AID & NURSING, SEPTEMBER/OCTOBER 1954

Nineteenth Edition. Completely revised. 26/5t thousand 286 pp., 286 illustrations, some coloured, 6s. 6d., post 4d. WARWICK AND TUNSTALL'S

FIRST

AID

TO THE INJURED AND SICK Edited by A. P. GORHAM, M;B., Ch.B., M.R.C.S.

Pol,ce SurgE'on, City and County of Bristol

'FIRST AID' WALL DIAGRAMS 26 X 40 in. A- G Anatomy and physiology. H - J The triangular bandage. K, L The roller bandage. M, N Ha!morrhage and wounds. 0, P Dislocations and fractures Q, R Transport. S ArtifiCial respiration.

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ADAM, ROUILL Y & CO.

The Brlt"h Red Cross Society have specially adopted a set of 6 sheets, A, D, M, N, 0, P, which can be supplied on linen with fittings for the special pr ice of 40s. post 8d.

Human Osteology, Anatomy, Etc. 18 FITZROY STREET, FITZROY SQUARE, LONDON, W.1 TELEPHONE: MUSEUM 1703

JOHN WRIGHT & SONS LTD., BRISTOL, 8

BAILLIERE BOOKS FOR FIRST AlDERS A HANDBOOK OF

ELEMENTARY NURSING Arthur D. Belilios, M.B., B.S •• D.P.H., and Dorothea Duncan-Johnstone, S.R.N. This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. ~t describes in simple language the bas~c principles and procedures that underlie ~ ~~ce~nur~& md ro~~I brief descriptions of the more common diseases, with general notes on the nursing required in each case. A c~mplete chapter is devoted to the subject of home nursing, and the wh.ole book provides for eve.ry ~st ruder the essentials of nursmg ill a handy yet comprehensive form.

.AIDS TO PRACTICAL HYGIENE Yvonne M. D. Cooper, B.Sc. and H. V. Davies, B.Sc. " ... An easily read, and easily underst?od: text~ook cover~g such subjects as home planning, heat, li.!?hbng, ~1I and venblation, food and values .. , The book IS w~ll lllus~rate~ and provides space for written answers to questlOn~ r~~sed l~ .t he , text ... The work is well worth the purchase pnce. (NUlsl11g N eilS.) 4 '11 t' 5 With 192 pages and 12 1 ustra Ions s.

NOTES 2s. 6d. ________ TEACHERS' __________ ~~~~

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IRST AID &: NURSING II

NOVEMBER/DECEMBER 1954

No. 703, Vol LIX

PRICE FIVEPENCE 3/3 per Annum Poa Free

A coachbuilt ambulance on a

Karrier chassis

are primarily caused by Staphylococci, Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms.

SKIN

THIS newly designed ambulance has accommodation for 2 stretcher patients, and the offside locker is convertible to accommodate four sitting patients facing forward. These seats are quickly removable before the carriage of an infectious case, thus rendering fumigation of the interior a qUick and simple operation.

INFECTIONS

ANTIPEOL CUTANEOUS OINTMENT is a preparation which incorporates the sterile ~roth filtrates of the three infective microbes III an ointment base of proved efficie~cy ~urther to accel~rate the process of rapid ,healing.

This ambulance is fitted with a wash basin, and tip-up attendant's seat.

T~E~TMEN~

{

fo; burns and scalds,

ANTIPEOL OINTMENT is both non-adhesive and

YOU ARE INVITED TO APPLY FOR FULL DETAILS OF MOBILE MEDICAL UNITS, AMBULANCES, ETC., BUILT TO YOUR PARTICULAR REQUIREMENTS FOR SERVICE IN ANY PART OF THE WORLD

PILe

ERS

AMBULANCE & MOBILE UNIT BUILDERS 314 Kingston Road, Wimbledon, S.W.20 47 High Path, London, S. W.19 Telephone: LiBerty 2350 & 7058

Telephone: LiBerty 3507

Printed br HOWARD, JONES, ROBERTS & LEETE, Ltd., 26·28 Bury Street, St. Mary Axe, London, E.C.3, and publisbed by the Propnetors, DALE, REYNOLDS & CO ., Ltd., at 32 Finsbury Square, London, E.C.2, to whom all communications should be addressed.

bactericidal thus obviating the need, when not convenient, of changing the dressings every day. FOR CUTS, ABRASIONS, BOILS and nu~erous skin infections, ANTIPEOL is unquestIOnably the remedy. It is already in widespr~ad u~e by the medical and nursing profeSSIOns In many parts of the world. ANTIPEOL is therefore

an essential component of every First Aid and Nursing Kit.

antipeol cutaneous ointment k of' ENTEROFAGOS for Produced by th~ ~a ers INO-ANTIPEOL for nasointestinal co~plamgpH¥NALMO_ANTIPEOL for ocular pharynx .infectlnonEsT;ENSYL for redllcing arterial tension. infections; RD., SOUTH NORWOOD, S.E.2S MEDICO-BIOLOGICAL LA BORATORIES LTD., CARGREEN

FIRST AID & NURSING, NOVEMBER/DECEMBER 1954

MEN'S UNIFORMS and LADIES~ GREAT ~OATS & ~OSTUMES for Divisions of the St. John Ambulance B.rigade can be obtained from

November/December 1954

News and Notes Grand Prior's Trophy Competitions

Gas Industry National Competitions

G. P. O. National Competitions

Unconsciousness

From a Seat in the Audience

Notes on Advanced Physiology

First-aider's crossword

AMBULANCE GEAR

Readers' Queries

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

no you know

Hop 2476 (4 lines)

'Grams:

"Hobson, Sedist, London"

"PORTLAND"

The UP AND DOWN action is quick and easy for loading or unloading. A. Shows the two stretchers in position. B. Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear with the top stretcher frame hinged crown for use when only one stretcher case is carried. D. Shows the same position as in "c' ouly with cushions and back rest fitted for convalescent cases.

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

This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.~.2, for .the purpose of providing an inf?rmative tecbmcal service on first aid and nursmg. We welcome contributions.

PATENT

\..

Editor: Peter I. Craddock

Casualties Union

r A

Nursing

In this Issue

UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS 154 - 164 TOOLEY STREET LONDON BRIDGE S.E.1

Full cotologue .f Ambulance Equipment No.7A will be scnt on request.

65, WIGMORE STREET, LONDON, W.I 'Phone I WELbeck 0071 (Late GREAT PORTlAND STREET)

News and Notes

HOBSON & SONS (London) 'Phone:

First Aid

that • •• 1. Salivary gland s secre?te an average of two pints of saliva per day . 2 Artificial respiration should never be performed in the case of asphyxia caused .by fumes from nitric acid, carbontet.rachlonde (used in pump-type fire extinguIshers) or trichlor ethylene? . 3. There are 206 bones m tl~e human body (adult), of which 34 are smgle and . 172 are in pairs ? 4. The sick from whom Chnst cast out . h devils were epileptics : S. Diabetes was ~rst descnbed by t e famous Greek physician A~etae~s, who f~a~ born in Cappadocia and lived 10 the Irs century A.D. ? . t d 6 The triangular bandage was IOven e in 1'831 by Dr. Mayor, of Lausanne,.and ,~as introduced into this country the fo.lIo~m~ year by the St. John Ambulance Assoclahon .

Red Cross Yugoslav Delegates Study Course The following recently visited this country for the purpose of studyini? Red Cross methods and facilities in BritalO :-:Mrs. SHEVlc.-Secretary of Ser?l3n Red Cross and member of Executive Committee of the Yugoslav Red Cross: Dr CEKIC. -Vice President of SerbIan ~ed Cross and member of Central CommIttee of Yugoslav Red Cros:>. Mrs. KRAJGER.-Secretary Slov~ne Red Cross and member of ExecutIve Committee of Yugoslav Red Cross. Mrs. DJURlc.-Secretary of the R~d Cross of Vojvodine Autonmous. RegIon and member of Central CommIttee of Yugoslav Red Cross. Mrs. DJORDJlc .-Secretary Belgrade ~ed Cross and member of Central ComIlllttee of Yugoslav Red Cross. Mr. GASl.-Secretary of. the Kosovo Netoluja Autonmous ReglOn . Mr. JAKOVLJEVIC.- Legal Officer of the Yugoslav Red Cross. . Mrs. STAMENKOvlc.-Serbian JUOlor Red Cross. . I' d The delegation were cOllslderab Y unp~esse and have taken back maT?Y new l.d~~s. They particularly noted the library faCIlitIes here, for, owing to the effects of the last war, there is a great need for general. development and education in. Yug?Slavla .. They visited the crippled chlldre.n s hospItal at Ely Red Cross branches In Kent, Ca.mbridge and Londor:, and hospitals, bemg interested in the antL-T.B. measures, and the social welfare schemes. Presentation of Mentorious First Aid Awards at Paddington Recently in the Board Room at Pad~lng ton K. W. C. Grand, ChIef RegIOn al Ma~ager who was supported by a number of Chiei' Officers, presented ten Class 1 awards (clock with an approjJnate engr~v~d silver plate and framed certI1'1ca.te) an SlX Class 2 awards (framed cer:tlficates) ~o members of the Western RegIon ~taff.' 10 recognition of exc~ptionally men~onous nrst aid rendered dunng the past yeal' A vote of thanks to Mr. Gran d ~as roposed by Gilbert Matthews, Operatmg

~uperintendent.

Southern Region Ambulance Centre-British Railways Districts Nos. 7 and 8 had a pleasan~ time at Weymouth recently. There v.: as series of useful lectures bX some ea~LOae~J doctors and surgeons, a dmner, lunc entertainment by a tale!lted concert party. The meetings were held 10 the local S.J.A.B. hall on the Saturday afternoon . and on Sunday The gatherings were preSIded ov~r b H C. Lang, Region a l Staff. Officer, .w 0 y '1 Chairman at the SOCIal functIOns. ~I~ a~~ng was supported by . Dr. L. J. H .d Chief Region a l MedIcal Officer. D~y T~np. Howkins, Medical Office r, East. . M J Lithgow Welfare Officer, and l~lg~, Tr~'tt 'Regional 'Ambulance Secretary. h~ndred S.R. first-aiders w~re present. including two ladies from Eastlelgh and two keen men from Jersey.

De Vere Shortt Cup Competition. The annua l competition for thIS Cup was held amongst the Liverpool and London Midland Region teams on ~he 8th Octo~er, 1954. Six teams entered WIth the followlOg result :Tala/marks Exchange No.2 149 14 8 Pollce No.1 Police No.2 144 Lime Street 140 Langton Dock 121 Alexandra Dock .. . 117 Mrs. Flindt (wife of the Goo~s Agent, Alexandra Dock) presented the pnzes. Chest Check-up for T.B. The steady decline in the tuberculosis death rate in Britain during recent years, was referred to by Dr. W. Hugh .Morton, Consultant Chest Physician,. Carltsle, a~d Medical Director, Mass RadIography ~Olt, special area of the Newcastle ReglOnal Hospital Board, addressing a . S~sslOnal Meeting of the Royal Sanitary InstItute at Carlisle on Thursday, 11th November. Dr. Morton was giving a paper or: ' Personal Protection of the Individual agamst Tuberculosis.' He said that m',ldern treatm~nt had contributed to the decline of mortaltty. , Patients,' he added, • are more f~eq uently cured while those not cured survIve for a longe~ period.' . . The speaker said that B.C.G. vaccmat.lon should be made available to all susceptIble individuals regardless of age .. Dr. Mo.r~on expressed the view that the Ideal pOSitIOn would be for everyon~ to have a check-~p every six months. WIth the present eqUIpment and personnel, however, they would be unable to deal with the numbers mvolved. Civil Defence Medical Study in London In a joint medical study, officers of the Middlesex County COl!ncil and the North West Metropolitan RegIOnal HospItal Board examined in London on 9th and 11 th November some of the problems of the medical care, treatment and transport of casualties likely to result from an attack by nuclear fission weapons. h The study was prepared under t e direction of experts from the Home Office, Ministry of Health, the RegIOnal J:IospLtal Board London Civil Defence RegIOn a~ld the L~ndon an d Middlesex Cou~ty Councl s as a training exercise for S~ntor do~t~rs, hospital matrons and hospItal admI~lst. the North West MetropolItan rators m d ' I Offi s of Hospital Region and Me lea cer Health within the same area.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1954

News and NoteS-continued Supersonic Treatment of Skin Disease Hungarian scientists are experimenting with ultra sound in the treatment of skin disea~es according to the journal Nature and Society . The research is being carried out by Professor Tamas Tarnoczy and his colleagues at the Medical Physics Institute. The journal says it has long been known that bacteria can be destroyed by ultra sound but it has not been established why certain bacteria are more resistant to sound than others. Experiments are first being carried out on surface skin diseases and later will be directed to therapeutic uses of ultra sound. Supersonic treatment of joint, rheumatic and muscle troubles has been used with good effect for about fifteen years, the article says, but closer examination of therapeutic use is desired. For tbe experiments on skin fungi the Institute is using a Hungarian manufactured equipment of 100 watts operating on 800 and 3,000 frequencies. To eliminate heat a water cooling system is used. Recruiting Spurt for Hospital Reserve With an increase of over 1,000 members in October, the National Hospital Reserve achieved its best recruiting figures for over seven months. The Reserve's total is now 39,553, made up of36,347 nursing auxiliaries and 3,206 trained nurses. .Wales, closely followed by Liverpool, ~tlll holds the lead for the highest number of members per 1,000 of population. Cambridge, who for several months were challenging Leeds for third place, last month overhauled their rivals, who dropped to fourth position. For the first time five out of the fourteen hospital regions have more than one member per 1,000 of population . The latest region to gain this distinction is the South West Metropolitan. Role of the Assistant Nurse Steps to increase the number of enrolled assistant nurses and to enhance their status are sugge.st~d in a report published recently by the Mmlstry of Health. This states that ~here is a place for more assistant nurses 1D nearly. every field of hospital and domiciliary nursmg. The report is by the Standing Nursing Advisory Committee of the Central Health Services Council. The Committee whose Chairman was Miss K. G. Douglas,'S.R .N., S.c.1:f. (Matron o~ St. ~ary's Hospital, Pa~dmgton , W.2) dIscuss m detail the role WhICh they consider the assistant nurse should occupy in the various branches of nursing within the National Health Service pa~i~g special attention to such matters a~ trammg, status and title, and promotion prospects. The Committee's findings regarding mental and m~ntal deficiency nursing are, however, not mcluded. This part of the report has been referred back by the Central ~ealth. Services Council for further conSideratIon by the Standing Mental Health aI?d Nursing Advisory Committees. OtherWIse, t?e report has been endorsed by the CouncIl, and the Minister of Health, Mr.

lain MacLeod, in sending copies to all hospital and local health authorities has commended it generally to their attention. London Transport Corps of the St. John Ambulance Brigade The First Dinner and Dance of the No. 89 London Transport Corps of the St. John Ambulance Brigade was held at South Kensington recently. The function was Rttcnded by over 100 members and friends , and the principal guest was Col. G. F. Page, D.S.O., Conunissioner No. 1 (Prince of Wales') Dlstnct of the st. John Ambulance Brigade. Other headquarters officials also present were District Superintendent (A) Mr. C E. Bower, O.B.E., and District Superintendent (N) Mrs. M. Cavendish. The Corps President, Mr. Alex J. Webb, General Superintendent (Staff and Training) Railways; Dr.. L. G. Norman, Chief Medical Officer; Acting Corps Surgeon Dr. J. L. Fyfe; and Hon. Corps Treasurer R. C. Hider, M.B.E., also attended. In proposing the toast to the Corps, Col. G. F . Page praised the work of the members and welcomed the expansion that had been n:ade dming .the past few years. He emphasIzed the high standard of the Brigade generally in No.1 District and was sme that the Corps would continue to maintain an equt..l1y high standard in its new Divisions. In reply the Corps Superintendent, Mr. E. L. K. Dunn, assured the Commissioner of the full support and co-operation of officers and members of all Divisions of which there were now twelve Ambulance 'and three Nmsing. He stated that this Dinner coincided with the 21st Anniversary of the granting 6f Corps status to the London ~ransport Corps although separate DivisIons had been operating for many years before that. Dr. L. G. Nonnan also spoke of the .inte~est taken by London Transport Execut.lve III the movement, to which they had gIven, and w~)Uld continue to give, every support pOSSIble. The evening concluded with a Dance and Cabaret Show. London Transport Ambulance Centre ~~e final of the 1954 First Aid CompetItIon for the Sister Hutchings Cup took place at Chis" ick Works on Saturday 27t~ November 1954, before a larg~ audIence. The .e~try of 55 teams for this year's C?mpetltJOn was a record one, and ten dlstnct Competitions were held to select t~e fifteen teams to take part in the Final. FIrst place was obtained by the Chiswick team led by Mr. J. Barnes with a total of 143 marks out of a possible 200, whilst the runners-up ~ere Clapham (Ieader-Mr. N. Stevenson) WIth 117 ~ marks. Manor House team (leader-Mr. G. Foley) were third with 115 marks and Reigate (Women) 'B' (leader-Mrs. H. Barrett) fourth with 113t . Other teams taking part were Dorking New Cross, Wandsworth, Sidcup 'A,' Baker Street (Women), Romford 'A' Dartford Romford 'C,' Hertford, Guddford and Watford. ' In the Oral test the winner was Mr. J. Talbott of Charlton who obtained the

maximum of 50 marks. Runner-up was Mr: F . Mulholland of Dorking with 49, whLlst Mrs. J. Farmer of Reigate was third with 45. The team test was judged by Dr. C R?t~an of Watford and the oral test by D~v~s~onal Officer D. Fenton of 85 (Baling) D1V1sJOn S.J.A.B. and the Cup and prizes to the first five teams were presented by Mr. G. Fernyhough, Divisional Superintendent (N) Country Buses and Coaches and Chairman of the Nos. 7 and 8 District~ of the Centre. Mr. J. B. Burnell, Operating Manager (Central Road Service) and President of the National Road Passenger Transport Ambulance Association presided and welcomed the visitors, with particular reference to Sister Hutchings who was in the audience. The staging for the team test was a public hou~e w~lere the team members were having a d.nnk III the pubhc bar. A gang of pickpockets operating in the Saloon Bar became engaged in a fight during which one was severely injured and a customer slightly injured. The injuries included a double fracture of jaw, severe haemorrhage from wound on right arm , a Pott's fracture of right leg, bruised right ribs and shock. The Institute of Certified Ambulance Personnel General Secretary.- Mrs. N. E. Berger, O .B.E., 5, Grove Terrace, London, N.W.5. Chairman. - Dr. W. W . Fox. President.- Dr. H . Morgan, M.P. :rhe above,of61 Cheapside, London,E.C2, WIshes to make its policy on the training of ambulance personnel known to the public and has therefore issued the following statement : This Institute was founded in 1945 with one of its chief aims the raising of standards of training and qualification in the ambulance profession which were not high enough to enable personnel to carry out competently their duties to the public. The Institute was represented on the Committee set up by the Minister of Health to enquire into the training of ambulance p~r~onnel (under the Chairmanship of Dr. LilIlco) and fought for a higher standard of qualification that the Committee was prepared to recommend. When the findings of the Committee were made known to Local Authorities in the form of recommendations (Circular 30/51), the Institute considered that at least these standards should be made compulsory. It is the desire of this Institute to see it accepted by all local authorities that no ambulance personnel shall go on duty until they have a thorough grounding in first aid. In addition the Institute claim that those who are employed in the position of shift leader and above should be in possession of ~he Ins.titLlte's Fellowship Diploma. As an Imme~lat.e proposal the Institute suggest that wlthm eIghteen months all shift leaders (and above) in post shall be in possession of the As~ociate Cer~ificate and be preparing for thell· FellowshIp examination. From a date to be agreed, the Institute ask that no shift leaders (or above) shall be appointed w~o have not gained the Fellowship DIploma of the Institute.

FIRST AID & NURSING, NOVEMBER /DECEMBER 1954 The Institute consider that the Fellowship Diploma, the syllabus of whi~h includes not only all aspects of first aId but also infectious diseases, resuscitation, midwifery and other special subjects should be recognised as permanent qualification for proficiency pay on the grounds that the standards the Institute demands for a pass in these subjects is far higher than that at present required by local authorities. The Institute consider that the present grading of ambulance personnel in th~ local authority staffing structure makes It Impossible to frame economic conditions for them which are commensurate with the job to be done and the responsibility taken, and whilst the Institute is not directly concerned with wages nor seeks to take any part in wage negotiations, they are very much in favour of ambulance personnel being classed as skilled workers which the Institute consider they are. The Institute are well aware that many local authorities give assistance and encouragement to their personnel to take the Examinations of the Institute and that preference is given in promotion to. t.h.os~ holding t~e Fellowships. But the IllltmtIve to obtam the training and. take the examinations rests upon the individual ambulance man or woman. In the interests of public service and safety, the Institute consider that local authorities should make their standards uniform and very much higher. Influenza Research The Medical Research Council in conjunction with the Ministry of H~alth ~s organizing trials of influenza vaccme th1s winter. About 16,000 men and women will take p art. They have already been selected at volunteer centres in industry throughout the United Kingdom. The trials have already started and four vaccines, all produced in this country, are in use. Barbara Kelly receives a Christmas Present for ' Peter Pan' Hospital Every year Messrs. Pimm's kindly lend their premises to the Order of St. John and the British Red Cross Society for a sale of handcrafts made by disabled service and exservicemen at clubs organized by the City and County of London Joint Committee Emergency Help and After Care Department. There are nine such clubs in the London Area, where disabled men and women can go for a social afternoon to meet together for tea, talk and games and. to learn various handcrafts, examples of whJch are on sale. This Sale is an opportunity for City men to buy an out-of-the-ordinary Christmas gift. Members from eight of these clubs have made a screen from hundreds of scraps, cut from Christmas cards, and this was presented by them as a Christmas gift to the Great Ormond Street Hospital. The presentation was made to Miss Barbara Kelly (this year's Golden Jubilee Peter Pan) by Mr. George Edward Larkins of 99, Fairlawn Court, Cherry Orchard, S.E.7. Mr. Larkins is a 100 p.c. pensIOner from the 1939/45 war. He is 29 years old and has been a member of the st. John and Red Cross Club at Wellington Road, Woolwich, for the past two years. Miss Kelly presented the screen to the Great Ormond Street representative Ralph Ince, a 7 year old patient.

CASUALTIES UNION Rescue from Crashed Aircraft A special exercise was staged at Renfrew Airport by B.E.A.C. at the request of Airport Commander C. D. Waldron, who was one of the two assessors in the recent inquiry into the causes of the air crash at Kallang Airport, Singapore, in which 31 passengers and 2 members of the crew lost their lives. The exercise was designed to explore fully the difficulties that would arise in the event of a medium air liner crashing. Ten trained , casualties' were provided by Lynedoch Branch of Casualties Union and rescue and first aid was carried out by the Airport Fire Service, St. Andrew Ambulance Association, Police an d Medical Staff. Liasion was undertaken by W. Macdonald, Civil Defence Officer, Glasgow. Miss C . M. Robb was the leader of the team of , casualties' which included 4 persons with scalp wounds, 6 fractures, burns, hysteria, dislocated shoulder and internal haemorrhage. Most cases had more than one injury and all suffered from shock. It was a most interesting evening and it is understood that it was not without success. Civil Defence Recruiting Drive The Civil Defence Authorities throughout the country have been making a special drive to enrol recruits. Casualties Union has provided 'casualties' to assist this programme in many parts of the country from Trafalgar Square, London, to remote villages in Cornwall, Essex and Northumberland. From the Ci,il Defence Officer of Bury, Lancashire, comes a ~etter stating : , Your displ ay ... will be talked over long after the demonstration has ceased to be remembered. Your efforts have revived new interest in the Civil Defence Corps.' Halifax Branch of Casualties Union under the leadership of Mrs. D. Crowther provided the' casualties.' Diagnosis Training for Boy SCOLIt First-aiders Scoutmaster D. Gibb of the 4th Newcastle Troop wanted to give his adv~nc~d firstaiders something to set them thmkmg and Harry Truman, District Commissioner, also a member of Newcastle Branch of CasualtIes Union staged a diagnosis exercise in which the Scbuts had to examine cases of collapse from fatigue and hunger, apoplexy, open fracture of tibia, complicated fractur~ of ribs and scalded leg and foot. The tramed , casualties' were provided by the Newcastle Branch. Weekend School for Dock Workers The National Dock Labour Board has been staging a series of Weekend Schools for

dock workers as part of the drive to recruit first aid teams in all the ports. Recently a course was held at Woodh all Spa, Lincolnshire, under the direction of Dr. R. R. Wilson of London. Dr. D. T. Richards from Bristol and the Dock Medical Officer also took part. Kingston-on-Hull Branch of the Union provided 'casualties ' for a team test and also for diagnosis practice. Lord and Lady Crook expressed their keen interest in the work of the ' casualties ' under the leadership of Miss Elsie Woods and Wm. Bromfield. The injuries portrayed were fractured patella, internal haemorrhage, anthrax, asphyxia, severe bums, fractured heelbone. One case who had been severely crushed had bleeding in both abdomen and chest. An asphyxiated case was severely burned. The candidates on the course were extremely keen and gained much confidence from the experience .

Atomic Casualties fo r Civil Def ence Dr. J. Stevenson Logan, Southend M.O.H. includes in all Basic Civil Defence Training Courses the exam ination and handling of a severe case of bodily exposure to extreme radiation. L. H . Davey of the Southend Study Circle No. 155 has been , casualty' on numerous occasions portraying radiation sickness and suffering fr.om laceration of the leg. Dr. Logan emphaSIzes the need for scrupulous care to prevent infection of the wound because of the reduction of blood formation caused by exposure to radiation. Demonstration in Manchester Mrs. Barrett and Miss Drayton, leader and secretary of the Altrincham Study Circle No. 140 discussed the work of Casualties Union with officers of the British Red Cross Society at the Rusholme Headquarters, Manchester 10. To demonstrate the art of acting the behaviour of injured persons, Miss Drayton put herself in turn into the shoes of ~ young girl in party shoes, an elderly lady 1D loose house shoes, and a charwoman in old shoes. Each in turn had to spra in her ankle and the audience were fascinated by the wide variations in the behaviour of the cases, none of which was exaggerated. . Several of the audience expressed theIr desire to form a study circle and Dr. Jenny Craig agreed to act as medical ~d.vise:. Expert medical ad vice and superVISIOn IS essential for all 'casualty' work whether elementary or advanced. and is. of paramount importance dunng trammg of , casualties.'

FIRST AID & NURSING, NOVEMBER /DECEMBER 1954

THE ANNUAL COMPETITIONS FOB THE

GRAND

TINKER, tailor, soldier, sailor- yes, they were all there, together with tbeir wives and sweethearts, at the Porchester Halls London to witness the Finals of the Competitions 'for the Grand Prior's Trcphies, for interest in this weat annual event penetrates to all sectIOns of the community. 1 he vast gathering of spectators included not only those associated with the st. John Ambulance Association, for many memcers of other organizations were to ce seen mingling with the crowd. From all parts of Great Britain came the competitors, and all sections of industry and commerce were represented, as will be seen from the following list of ]2 men's teams and 7 women's teams : Men: Teams,' (A) Exmouth Junction M.P. No. 1 team representing British Railways and London Transport (Railways). (8) Wolverton team representing The St. John Ambulance Brigade. (c) Birmingham City Police team representing National Police. (D) Exeter team representing British Transport Commission Police. (E) NOlih Area, TM.O. team representing General Post Office Ambulance Centre. (F) S. D . Elstow team representing Ministry of Supply Ambulance Centre. (G) Brighton team representing British Electricity Ambulance Centre. (H) Chiswick team representing National Road Passenger Transport Ambulance Association. (I) Whitwick No. 1 Colliery team representing Miners' National First Aid Competition. (J) Eastern Gas Board team representing Gas Industry. (K) Great Yannouth team representing National Fire Brigades. (L) Windscale team represen ting United Kingdom Atomic Energy Authority.

TROPHIES

Chiswick team representing National Road Passenger Transport Ambulance Association. (G) Aldermaston team representing United Kingdom Atomic Energy Authority. The above were faced with no easy task in their struggle for supremacy, for the tests, once again, proved to be just as severe as any set in previous years. In addition to the team test, each team was split up into pairs, each pair being subject to a further test, this applying to both men and women. The tests were devised by the following judges : Dr. William Duncan, of Liverpool (Men's team test) ; Dr. M. M. Scott, of London (Women's team test) ; Dr. C. H . Drake, of Gloucester (Men's dual practical tests) ; Dr. F. Harman Vollum, of Alvechurch (Women's dual practical tests). In the men's team test the members are supposed to be travelling on the top deck of a 'bus when they see a man in the roadway staggering and weaving as though drunk. He falls to the ground, face downwards, whilst trying to open his dispatch case. He is heard to mumble' sugar-case.' A woman runs from a telephone kiosk to assist. The weather is fine, the time 1 p.m. Injuries,' Overdose of insulin, severe mixed haemorrhage from carotid artery and jugular vein, incised wound on left side of neck, fractured neck of left femur, toxic and haemorrhagic shock. The members of the women 's team are purchasing groceries at a small village store when a cry is heard from the other end of the (F)

shop and the grocer's assistant is seen to have fallen from a ladder across a packing case with his right leg caught in the rungs. Injuries.' Dislocated right shoulder, wound in middle of left arm with severe haemorrhage, fractured lower end of right leg, severe shock. In the men 's dual practical tests Nos. 1 and 3 discover a night watchman lying face downwards by his coke fire with his feet still in his box. Injuries.' Unconscious and not breathing, burns on left forearm and left leg. For Nos. 2 and 4 there was a similar setting as for Nos. 1 and 3, but the victim was suffering from different injuries. Injuries.' Unconscious but stertorous breathing, Rushed face, suggestion of paralysis of left side and left upper and lower limbs. Nos. I and 3 of the women's teams are passing a country workshop when they hear a shout, and find a man who has upset a kettle of boiling water. Injuries ,' Scalds to feet and legs. For Nos. 2 and 4 the setting was similar but this time, instead of upsetting a kettle, some heavy articles had fallen from above, striking his head. Injuries.' Slight head wound with concussion. The team tests had to be completed in 15 minutes and the dual practical tests in 7 minutes. In order that he might have an opportunity of expressing his appreciation of their great interest in the work of the St. John Ambulance Association, the DirectorGeneral, Mr. Horace F. Parshall, T.D.,

FIRST AID & NURSING, NOVEMBER/DECEMBER 1954 M.A. (Oxon) had invited the following to lunch with him at St. John's House: J. B. Burnell, Esq., Operating Manager, Central Road Services, London Transport Executive; Sir Ben. Barnett, K.B.E., C.B., M.C., Deputy DLrector-General, G.P.O. ; J. Barnett, Esq., Chief Constable, Police Headquarters, Leeds; The Hon. John Bruce C.B.E., Principal Secretary, Priory for Wales Order of St. John; Sir Ernest Burdon, K.C.I.E., C.S.T., LL.D., ReceiverGeneral, Order of St. John; The Lord Crook, Chairman, National Dock Labour Board ' Sir Conrad Corfield, K.C.I.E., C.S.I., M.c., County Director for Berkshire; Vaughan N. Dean, Esq., Associated British Picture Corporation Ltd.; Col. A. V. G. Dower, Oxford Association County Director; C. T. Evans, Esq., C.M.G., SecretaryGeneral, Order of st. John; The Hon. Mrs. Leslie Gamage; Mrs. B. Grosvenor, C.B.E., Deputy Superintendent-in-Chief; Brigadier V. F. S. Hawkins, D.S.q., M.C., County Director for · Dorset; Sir James Helmore K.C.M.G., Permanent Secretary, Ministry' of Supply; B. R . W. Hill, Esq., County Director for Devon; Sir Lewis B. Hutchinson, K.B.E., C.B., Ministry of Supply; A. H. Johnstone, Esq., C.B.E., M .T.Fire.E., Chief Fire Officer, Surrey Fire Brigade' Major A. C. White Knox, O.B.E., M.C., M.B., Ch.B., Principal Medic~l Officer, The St. John Ambulance ASSOCIation' Lt-General Sir Otto Lund, Commissio'ner-in-Chief, S.J.A.B.; Sir Frank Newsan, K.B.E., C.V.O., M.C., Permanent Under-Secretary of State; J. Parkin, Esq., O .B.E. , M.C. , Department of Atomic Energy; Dr. C. Petvin Porter, .County Director for Worcester; W. B. Richards, Esq., M.V.O ., British Transport Commission; Sir H . C. Sinderson Pasha, K.ll.E., C.M.G., M.V.O., M.D., County Director for Sussex; Sir Harold Smith, K.B.E., Chairman Gas Council; Mrs. E. Stewart-Roberts; J. Tennant, Esq ., T.D ., County Director for Kent; Lt.-General Sir Henry Pownall, K.c.ll., K.B.E., D.S.O., M.C., Chancellor of the Order of St. John; Lt.-Col. E. C. Croft, Deputy DirectorGeneral, S.J.A.A.

PRESENTATION Shortly after 4 o'clock, after the scenery had been removed, Mr. Parshall presided at the presentation ceremony, and was supported by Sir Ernest Burdon, Mr. C. .T. Evans, Lt.-General Sir Otto Lund, Major

A. C. White Knox, Lt.-Colonel E. C. Croft, The Mayor and Mayoress of Paddington, Mrs. Stewart-Roberts, Mrs. B. Grosvenor and the judges. Mr. Parshall said he wished to thank the Chancellor of the Order, Lieut.-General Sir Henry Pownall, for having so graciously undertaken to present the awards that afternoon. This was no trivial task on his part, for he had always taken a very great interest in the National Competitions of the Association which had added so much to the reputation of the Order. He wished, also, to thank the teams which were there that day, and which had attained so high a standard in their work.

It was again his pleasant duty to thank the Associated British Picture Corporation Ltd. for their continued generosity in supplying and erecting those amazing scenes and creating that realism which contributed so greatly to the success of the events. Not merely year by year, but month by month they had carefully and quickly set these scenes, and then as quickly removed them in time for the presentation ceremony to take place. Next he thanked the judges, Drs. Duncan, Scott, Drake and Vollam. What . an incredible debt we owe to the medical profession, he said, for they are the only people competent to teach the laymen, examine them for their certificates of proficiency and judge the competitions. In response to the Chairman's invitation Dr. Duncan commented upon that part of the Competitions which he had judged. He opened by saying' I must thank. you for asking me to judge lo-day. T believe the competitors have learned a great deal from the tests, but I myself have also learned a lot.' Most of the te-ams had done well, but there had been some bloomers. Perhaps, however, some of these had been due t.o flurry. In the men's team test the emphaSIS had been on the control of haemorrhage. , Whatever injuries there may be, ' he said, , you must stop bleeding.' In lecturing to his own students he was always most particular in teaching the proper way to arrest haemorrhage. Dr. Scot followed, saying that he considered it a great honour to be called upon to judge at the Grand Prior's Trophy Co~ petitions. With regard to the wome!1 S team test he said that those teams whIch had failed had been those teams which had

Women (A) Glasgow tenm representing British Railways and London Transport (R ai lways). (8) Brighton team representing The Sl. John Ambulance Brigade. (c) South-West Area, TM.O. team representing General Post Office Ambulance Centre. (D) S. D. Elstow team representing Ministry of Supply Ambulance Centre. (I) Swindon team representing British Electricity Ambulance Centre.

The winning men's teamBirmingham City PoHce

The winning women's teamBrighton S.J.A.B.

failed to take advantage of everything around them. Every test must have an object, and in this test the object had been observation .

THE RESULTS At this stage the results were announced by Lieut.-Col. Croft, the Deputy-DirectorGeneral, and were as follows : -

(Maximum marks obtainable 400) Men Marks 1. Birmingham City Police 320 (Winning tre Championship Trophy) 2. Wolverton S.J.A.ll. 300~ 3. North Area T.M.O. (G.P.O.)... 296 280 4. Exeter (B.T.C. Police) 5. Whitwick No. I Colliery 279 6. Great Yarmouth Fire Brigade 274 7. S. D. Elstow (Ministry of Supply) 273 8. Brighton (British Electricity) ... 265} 9. Eastern Gas Board 264! 10. Chiswick (Nat. Road Passenger Transp.) 257 11. Exmouth Junction M.P. No. I (B.R.) 251 12. Windscale (U.K. Atomic Energy Authority) 239t Women Marks l. Brighton S.J.A.B. ... ... 294 (Winning the Championship Trophy) 2. Chiswick (National Road Passenger Transport) ... 283 3. S.W. Area, T.M.O. (G. P.O.) ... 273~ 4. S. D. Elstow (Ministry of Supply) 265~ 5. Glasgow (ll. R. and London Transport) 262 ~ 6. Aldermaston (U.K. Atomic Energy Authority) ... 223 7. Swindon (British Electricity) 220 Responding to the invitation of Mr. Parshall, Lieut.-General Sir Henry Pownall, K.c.ll., K.B .E., D .S.O., M.C., Chancellor of the Order of St. John, deputizing for the Grand Prior presented the Trophies and then address~d the assembly. 'The Competitions for the Grand Prior's Trophies' he said 'have in five years, become an instituti~n, and'l hope will continue to ~e one. I hope, also, that you, Mr. Mayor, WIll continue to honour us.' He went on to say that he had been asked to express the d~ep regret of the Grand Prior who would like to have been there, but was unavoidably prevented. • I am afraid that [ am a ver~ inferior substitute, but r WJlJ do my best he added, amidst laughter. He said ~hat he had come there that day because ~e hked to see the progress which was bell1g mad"! every year by the competitors. . 1 do ,not know very much about first aid myself he said, ' but I do know that the treatm~nt for a drowning man. would not be ~he same as that for a man With a broken leg (laughter). He felt that competitions had ~one mu~h to raise the standard of efficiency 111 first aLd, and he drew attention to the notes o~ the programmes which he bel,ieved th~ audience would find most interestll1g. ThiS was the greatest event of the year, and the teams they saw there that day were the cream of the ambulance movement,

FIRST AID & NURSING, NOVEMBER/DECEMBER 1954

GAS INDUSTRY NATIONAL COMPETITIONS MR. THERM and his colleagues are not only capable of providing light a~d heat but many of them are also experts In the art of rendering first aid to the injured, a fact which was conclusively proved when the fourth Annual National First Aid Competitions between Area Boards of the Gas Industry took place at the Conway Hall, London. The twelve teams taking part in these Finals were those which had been successful in the eliminating competitions of their respective Area Boards, viz. : Eastern Gas Board; East Midlands Gas Board; Wales Gas Board; Northern Gas Board; South Eastern Gas Board; Southern Gas Board; North Western Gas Board; Scottish Gas Board; South Western Gas Board; West Midlands Gas Board; North Eastern Gas Board; North Thames Gas Board. Each team took part in a collective, or team, test, in which the members were required, in a specified time, to render first aid to the victim or victims of an accident which was portrayed in a realistic setting on a stage. There were, also, individual tests, involving oral examinations and/or treatment of a case of supposed disability. Needless to say, the nature of the tests was not disclosed until the moment the teams were required to undergo them. The tests were held under the General Rules of the St. John Ambulance Association, which provides for both team and individual tests by teams of four members, with one reserve who may be called upon if required. The judges were: Dr. W. N. Booth, of Harlow, Essex (team tests); Dr. C. J. P. Seccombe, of Southall (individual tests). In the team test the members were caJled upon to treat a housewife who had collapsed in the kitchen whilst frying breakfast, upsetting the frying pan over her bare arm. She was semi-conscious, but did not reply

to questions. Examination revealed that she was suffering from apoplexy, scalds on left arm, simple fracture of left leg near ankle with paralysis of right side of body. Medical aid is not available for at Least 20 minutes, ' but an ambulance will arrive 10 minutes after being called. The individual tests, perfornled in pairs, were equally interesting. For numbers I and 3 the site was a wharf, where the foreman (acted by thc judge, Dr. Seccombe) was interviewing two new employees (the competitors). Suddenly a cry was heard, and it was seen that a man, who had accidentally stepped into a loop of rope attached to a pulley, was hoisted into the air by his ankle. Injllries: Bruise on forehead, concussion, friction burn of right ankle and shock. He is unconscious for about three minutes. Numbers 2 and 4 had to deal with a man who had attempted suicide. Examination revealed that he was suffering from corrosive poisoning (ammonia) and knife wOLnds of the left wrist. Both individual tests had to be completed in 7 minutes. After the Competitions, which lasted from to o'clock in the morning until nearly 4 o'clock in the afternoon, had been completed, and the judges had had an opportunity of checking their marking sheets, the spectators assembled in the Great Hall, from the platform of which the scenery for the team tests had been removed and replaced by a long table on which was displayed the ChaIle\lge Trophy and Plaques. The chair was occupied by Lt.-Col. E . C. Croft, Deputy Director General, who was deputizing in the unavoidable absence. of Mr. Horace F. Parshall, T.D., M.A.(Oxon.), and he was supported by Sir Harold Smith, K.B.E., D.L., Chairman of the Gas Council, who had kindly consented to present the awards.

In introducing Sir Harold Smith, Col. Croft apo logized for the absence of Mr. Parshall, and proceeded to extend his welcome to all those prcsent, addressing himself particularly to those spectators from the Gas Industry. There is scope in the whole country for wide interest in this important subject. In commenting upon the work of the competitors the judges, Dr. Booth and Dr. Seecombe extended their thanks to the members of the teams whom they congratulated upon the excellence of their work, for they had done very well. They emphasized the importance of observation. The teams which had done best were those who had carefully observed the surroundings before rushing forward to deal with the patients. The results were as follows :(Marks possible 400) Marks TEAM: Individual Team Tara I. Eastern Gas Board 158 165 323 (Winncrs 1953) 2. South Eastern Gas Board 143 173t 316t (Winners 1952) 3. North Western Gas Board 130 185 315 (Winners 1951) 4. North Eastern Gas Board 139 174 313 5. North Thames Gas Board 120 ] 90 310 6. Southern Gas Board 126 159~ 285t 7. Northern Gas Board 99 163 262 8. East Midlands Gas Board 119 139 258 9. South Western Gas Board 119 136t 255t to. West Midlands Gas Board 126 129 255 11. Wales Gas Board ... 102 143 245 114 217 12. Scottish Gas Board ]03 Responding to the invitation of the Chairman to present the Trophies, Sir Harold said 'I shall ask Col. Croft to convey to Mr. Parshall my deep regret at his unavoidable absence this afternoon.' He went on to say that two minutes before taking his place on the platform he did not know the results of the Competition, and it was with no little shock that he heard that the Trophy had been won by the Eastern Gas Board for the second year in succession. Although the members of this year's team came from Tottenham, as did those in last year's team, it was a new team altogether.

Winners of this year's National First Aid Competition-the Eastern Gas Board team-are seen with (centre) Sir Harold Smith, K.B.E., Chairman of the Gas Council and Sir John Stephenson, Chairman of the Eastern Gas Board. Members of the team are: Mr. G. Maynard (Captain) with Trophy, Mr. E. W. Olney, Mr. J. E. Caudery, Mr. F. E. Pye and Mr. L. R. Sutton (reserve).

FIRST AID & NURSING, NOVEMBER/DECEMBER 1954

G. P. O. NATIONAL COMPETITIONS No less than 15 men's teams and 12 women's teams entered for the General Post Office National First Aid Competitions, heJd under the auspices of the st. John Ambulance Association at the Porchester Halls, London. They were the teams which had won the eliminating contests held in the various directorates, regions and departments, and are set out below : Directorates : Northern Ireland: A. Belfast T.M.O. (Men), A. Belfast T.M.O . (Women); Scottish: B. Inverness H.P.O. (Men), B. Galashiels H.P.O. (Women) ; Wales and Border Counties C. Cardiff P.O.A.C. '(Men), C. Cardiff P.O.A.C. (Women); Regions: North Eastern: D. Sheffield T.M.O. (Men), D. York H.P.O. (Women) ; North Western: E. Barrow-in-Furness H.P.O. (Men); E. ' Liverpool T.M.O. (Women); London Telecommunications: F. North Area T.M.O. (Men), F. South West Area T.M.O. (Womell); South Western: G. Weymouth H.P.O. (Men), G. Bristol T.M.O. (Women); Midland: H. Birmingham P.O.A.C. (Men), H. Birmingham P.O.A.C. (Women); London Postal: I. London Parcel Section (Men), Home Counties: J .Newbury P.O.A.C.(Men), I. Ipswich H.P.O. (Women) Departments: Savings Bank: K. Blythe Road S.B.D. (Men), J. Harrogate S.B.D. (Women); Factories: L. Edinburgh Factory (Men), Engineering: M. London Test Section (Men); K. Engineer-in-Chief's Office, City (Women); Headquarters, London: N. Headquarters Building (Men), L.A.G.D. Headquarters (Women); Supplies: O. Edinburgh Depot (Men). The judges were: Dr. J. Trefor Watkins, of Arnold (men's team test); Dr. A. M . Pollock, of Tunbridge Wells (men's individuaJ tests); Dr. G. M. Shaw Smith, of London (women's team test) ; Dr. John T. Daly, of Birmingham (women's individual tests). Both team and individual tests were by no means easy and called for considerable knowledge and skill on the part of the competitors, especially in diagnosis. In the men's team test the competitors were called to treat a man who had been injured in a street fight. He was found lying on the ground, and when spoken to just groaned, and was in a very dazed condition. His injuries proved to be contusion of right orbit (' black eye '), fracture of right lower jaw, fracture of right lower ribs with internal haemorrhage and compound fracture of tight tibia. The women's team test was eq ually tricky. The members of the team, out walking in the country, discovered a cyclist on the !oa~ way lying [ace downwards entangled In hls machine. Injuries proved to be a depressed fracture of skull with unconsciousness, compound fracture of left forearm near elbow, graze on right shin and fracture of right fibula near ankle. In the individual tests the competitors worked in pairs. Nos. I and 4, men, found a man lying in a garden frame on a lawn surrounded by broken gLass. There was a ladder near. Injuries were bruise on side of head with concussion, deep incised wound

half-way between right knee and hip joint posteriorly. He replied to questions somewhat garrulously and did not appear to know what had happened. Nos. 2 and 4, men, heard a cry from a c9ttage and, upon investigation, found an elderly man alone in the cottage and lying on the floor, where he had been for about an hour. Injuries proved to be fractured neck of left femur, Colles' fracture left forearm, slight cut inside cheek from false teeth . In the women's individual tests Nos. 1 and 4 saw a man fall whilst tying his shoelace with his foot on a chair. Upon examination he was found to be suffering from a bruise on left forehead, fracture of left clavicle and shock. He was unconscious but recovered consciousness after one minute. If asked he complained of pain in head and left shoulder. Nos. 2 and 3 were called to help a woman who had cut her wrist with a broken plate. She fainted, and in falling struck and fractured her right jaw. She is also unconscious for a short time. At the Presentation Ceremony, the Chair was occupied by Mr. Horace F. Parshall, T.D., M.A.(Oxon .), Director-General of the St. John AmbuJance Association, who was supported by Sir Ben Barnett, K.B.E., C.B., M.C., Deputy Director-General of the General Post Office, who had kindly consented to present the Trophies, Sir Henry Pownall, Chancellor of the Order of St. John, Lt-Col. E. C. Croft, Deputy Director-General of the Association, Col. G. F. Page, D.S.O. , M.B.E., Commissioner, No. 1 (Prince of Wales) District, Col. Dower, Commissioner for Oxford, Brig. Gen . Hayne, Commissi ' 'mer for Birnlingham and Lt-Col. Gueritz, M.A. (Oxon.), Secretary-General of the Order of st. John. Mr. Parshall , in introducing Sir Ben Barnett, said that it was again his pleasure to welcome Sir Ben, for the G.P.O. were still making steady contributions to the ambulance movement. To some extent these occasions were family ones, but they were pleased to see the new faces whic~ we~e constantly being added. It was agam hiS pleasure to express the gratitude ~f the Association to all those who had contnbuted to the success of that day'::; event. Thejudges deserved their heartfelt "thanks for so kindly giving both time and skill to assist in this great work. The stewards and \ patients' they could not thank too much, and. he thanked all those, too numerous to mentlOn, who had contributed in various ways to the success of the Competitions. Dr. Watkins spoke for himself and for Dr. Pollock, both of whom had been engaged in judging the men's team ~nd individual tests. He commenced by saymg 'Thank you' for the privilege of coming there. They had judged 15 teams between them, and it was most difficult to do each team justice. All the teams were not equally good, some were outstandin~. Perhaps the two principal faults he and IllS colleague had found in the men's leams were (a) lack of proper briefing (b) did not use eyes and heads. Dr. Shaw Smith spoke for himself and for Dr. Daly, both of whom had judged ~he women's competitions. After expressmg

7 their pleasure in being there that day-' We have enjoyed every minute,' he said-he claimed that it was the function of judges to criticize, but he hoped that their criticisms would be appreciated. In the first place it had been felt that the competitors had not put sufficient' zip' into their work. The same mistakes were made every time, and he classified these as follows : (a) Breathing should be carefully noted (b) Removal of clothing sho uld be better, slick' was the word he used- (c) Bandaging should be firm (not tight). Results (The marks obtained were from a maximum of 400)

Men ]. London North Area T.M.O. 316~ (Winning the Champion Trophy, a S1. John Knight) 2. Birmingham P.O.A.C. ... ... 278 ~ (Winning the Runners-up Trophy, Silver Cup) 3. London Headquarters Building 253~ 4. Blythe Road, S.B.D. 243 ~ 242 S. CardiffP.O.A.C. ... 231 6. London Test Section ... 224 7. Weymouth H.P.O. 8. Belfast T.M.O. 222~ 9. Barrow-in-Furness H.P.O. 220~ ]96t 10. London Parcel Section 172 11. Sheffield T.M .O. 157 12. Edinburgh Factory 143~ 13. Inverness H.P.O. 119~ 14. Newbury P.O.A.C. 101~ 15. Edinburgh Depot Nos. 2 and 3 Belfast T.M.O. and Nos. 1 and 4 North Area T.M.O. tied for the Best Pairs Trophy, small Silver Cup. Marks Women 1. London South West Area T.M.O.... 306i (Winning the Champion Trophy, Rose Bowl) 2. Harrogate S.B.D. 295 (Winning the Runners-up Trophy, Shield) 3. Birmingham P.O .A.c. ... 290 4. York H.P.O. 281 5. London A.G.D. Headquarters 268t 6. BelfastT.M.O. 2641 7. Bristol T.M.O. 258! 8. Galashiels H.P.O. 257 9. CardiffP.O.A.C. 250 10. Ipswich H.P.O. . . . : . . 244t 11. Engineer-in-Chief's Office, City 241 ~ ]2. Liverpool T.M.O. 227t Nos. 1 and 4 London A.G.D. H~ad quarters won the Best Pairs Trophy, Silver Cup. Before presenting the Trophies to the successful winners Sir Ben Barnett asked to be excused for quoting 'Some are born great, some acquire greatness an? so~e have greatness thrust upon them. Arnl~ laughter he said' I am in the last category. He went on to state that the Postmaster General takes a very great interest in th.e work of the St. John Ambulance ASSOCIation, but, unfortunately, he could not be there that day-' so you must put up wlth me '-he added. Sir Ben said that he had a great regard for those in. thco: Post . Office who gave so much of therr .le lsur~ tlffie to the study and practice of Frrst Ald.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1954

COURSE IN ELEMENTARY FIRST

AID

By A. D. Belilios M.B., B.S. (Lond.), U neonseionsness D.P.R. (Eng.) THE unconscious patient is often a difficult problem for the first-aider since there are so many possible causes for his condition. Hence, generally, the sooner he is in hospital the better, for here his case can be thoroughly investigated by doctors who themselves may find him a ' puzzler.' Nevertheless every first-aider has to be well-up in unconsciousness, since it is a common complaint and always requires immediate action before medical assistance is available. Moreover, the history of the case and the 0 bservations made by the first-aider may considerably help the doctor in his diagnosis. Thus, a man was recently found unconscious at the foot of a ladder which he was using to decorate a house. Guesswork suggested a head injury due to a fall, but his position, the arrangement of his equipment and other details observed by a competent first-aider did not fit in with a fall from the ladder. Actually the patient had suffered from a stroke while approaching the ladder-he had never climbed it at all ! Causes of unconsciousness.-These are best divided into two main groups (1) Primary, in which injury or disease affecting the nervous system is the direct cause and (2) Secondary, in which another system of the body is first affected and in consequence the brain, which is the seat of consciousness, is ultimately affected. If this method of classification is adopted, the numerous causes of unconsciousness can be divided up as follows :Primary: (1) Head Injuries.-(a) concussion (b) compression (c) fractures of the skull. (2) Diseases.- (a) apoplexy (b) epilepsy. (3) Psychogenic.-e.g., hysteria. (4) Poi~ons.-e.g., those acting dIrectly on the brain such as narcotics. Secondary: (1) Sh.ock.-Including fainting. (2) Dlseases.-(a) Diabetes (b) Uraemia (c) Infantile.

(3) Compliccltions of accidents.(a) asphyxia (b) haemorrhage. (4) Poisons.-e.g., those acting indirectly on the brain-insulin poisoning. (5) Miscellaneous.-e.g., effects of heat, starvation, etc. There remain other rarer causes such as poliomyelitis, tumours and abscesses of the brain, meningitis, etc., which are not included in the above classification to avoid overburdening the memory of the firstaider. Depths of unconsciousness.-Two degrees of severity of unconsciousness are usually recognized, stupor and coma. In stupor, the patient can usually be roused, although with difficulty, and may answer questions of a simple nature; the comatose case, however, is deeply insensible. Other distinctions, depend on the eyes as follows (J) Pupil reaction (2) Corneal reflex. (1) Pupil reaction: Normally when a light is shone into the eye, the pupils become smaller, this being called the reaction of the pupil to light. ] n stupor, the reaction is present; in coma, it is absent and the pupils remain fixed. (2) Corneal reflex: In this test the first-aider raises the upper eye~ lid with his forefinger and then with his second finger very gently touches the cornea. In a case of stupor, the lower eyelid at once blinks or the patient even moves his head to avoid the sensation. The corneal reflex is then said to be present; in coma, however it is absent and no movement of the lower eyelid occurs. Investigation.-The amount of investigation undertaken by a firstaider to find the cause of a case of unconsciousness depends, as has been mentioned, on the length oftime likely to elapse before medical facib ties become available. If jt is likely that there will be delay, investigation must include taking a history and examination of the patient. Some cases, however, such as epilepsy can be quickly diagnosed. ' The history must, of course be obtained from relatives or witn~sses of the case; the patient himself

will not be able to help much except after his recovery when, as will be seen later, his evidence may be valuable, e.g., in concussion. Witnesses and relatives must be questioned as to the possibility of injury, former attacks of a similar natur~ which would suggest epilepsy, hystena, etc., and also as to the recent health of the patient. If, for example, the patient is known to have been suffering from high blood pressure, apoplexy will become the suspected cause. An important point in historytaking is the nervous health of th : patient. A history of depression, w<?r~y, etc., may suggest attempted sUlcide as a cause, and in this event the first-aider must be like a detec~ tive-looking for clues such as thtS farewell letter, empty bottles of tablets or other drugs near the patient or the glass from which a patient has recently drunk. The examination should be thorough and it is best to work from the head downwards. The head should be examined for injury -wounds and bruising-while the eyes may provide valuable clues ; pupils unequal in size suggest a head inj~ry .or apoplexy, small pupils: pOIsonmg by a narcotic drug while i~ the eyes themselves appe~r persIstently turned towards one side apoplexy again is a likely diagnosis: The ears should be examined to see if there is a discharge of blood or watery fluid and similarly the n?se. The odour of the breath may give a helpful sign-perhaps of poison or in diabetes a faint smell like nail varnish (acetone). Convulsions-irregular and usually violent movements of the limbs an~ body-will be quickly noticed, whlle slight convulsions such as twitching of muscles will be readily observed. Paralysis (loss of use) of muscles is not so easy to detect during actual unconsciousness. Nevertheless examination may reveal that one side of the body is , bmper' than the other' or one side of the face may not be m~ving during breathing as much as the other.

FTRST AID & NURSING, NOVEMBERIDECEMBER 1954

Rigidity,i.e.,stiffness of the muscles, may be obvious when the patient's teeth are firmly clenched and the first-aider is unable to open the mouth as in epilepsy. This muscular spasm can also be detected by an examination which includes attempting to move the joints of the patient when they will be found to be stiff. Incontinence of urine or faeces due to loss of control of the bladder or rectum may supply an important clue in diagnosis. Thus a young girl had a fit while travelling in a bus. Only a vague history could be obtained since she had quickly been removed to hospital, and she had never had a previous attack. Examination, revealed, however, definite evidence that she had been incontinent of urine which occurs not infrequently in epilepsy. This was in fact her first epileptic fit. The above signs are those of particular importance in unconsciousness, but the remainder of the general examination of a patient must not be neglected and must include noticing the colour, the condition of the skin, the temperature and breathing. The significance of these signs will become clear as the various causes of unconsciousness are described in future articles. Principles of treatment.-All the general principles of first aid apply in unconsciousness. Urgent conditions such as bleeding or asphyxia must be treated immediately. The patient should be laid on his back but his head turned to one side to prevent the tongue from slipping

backwards into the throat and causing difficulty in breathing. Such difficulty will be recognised by hearing a ' gurgling' sound in the throat and by the colour of the patient becoming bluish. It can be corrected by pushing the lower jaw forwards by its angle, so that the lower teeth almost overlap the upper; in this way the tongue is drawn from the back of the throat. If this fails, the mouth must be opened, the tongue grasped by the forefinger and thumb and pulled forwards. A clean piece of material e.g. a handkerchief, must be placed between the digits and the tongue to prevent slipping. As regards position, the head and shoulders should be kept flat when the face is pale and the feet and legs may be raised; when the face is flushed, the head and shoulders should be raised. It should be noted , however, that the S.J.A.A. manual advocates raising the head and shoulders in concussion of the brain despite the fact that the face is pale. There is, of course, a reason for this teaching which will become evident when concussion and compression are discussed. So far as giving fluids and stimulants is concerned, as a general principle they should not be administered to an uncvnscious patient, since there is a risk that they wjl\ pass into the air passages and cause asphyxia. Even if this complication does not occur, a few drops of fluid inhaled instead of swallowed may set up aspiration pneumonia, a

serious condition. There are, however, exceptions to e~ery rule. Thus a semi-conscIOus patient may be able to swallow and it may be very desirable to give carefully sips of fluid, e.g., if a diabetic shows signs of going into a coma. In this event, ability to swallow must first be tested by turning the head to one side and introducing a few drops of sterilized water into the mouth between the cheek and the gums. The characteristic movements of swallowing if noticed by the first-aider supply evidence that it is safe to proceed. Nevertheless in the majority of cases of unconsciousness stimulants and fluids are unnecessary and should be withheld, even if the patient is able to swallow, until medical advice has been obtained. Other general principles of first aid include undoing tight clothing, ensuring an adequate supply of fresh air and supplying warmth. For the latter purpose, blankets or substitutes should be employed surrounding the patient; hot water bottles and other heating devices are no longer commonly used in first aid; reliance is placed on mabng use of the patient's own body heat, the wraps preventing heat loss from the skin surface. Excessive warmth must be avoided. Continuous observation is always necessary not only with the object of dealing with any emergencies that arise such as obstructed breathing, but also to provide a full report to the doctor.

comments From a seat in the audience Some random and provocative on the competitions Grand Prior Haemorrhage from carotid - correct position of hands is most important. Once again we heard that sergeant-major's voice. This is not consistent with good bedside manner. A member of the Brighton Nursing Division, S.J.A.B. team, Mrs. 1. L. Blackman was the mother of the captain, Miss Irene Blackman. Is this a unique case. Why did the women not ask the shopkeeper to assist in lifting and releasing the patient? When women obtain help from a man, let him take the heavier end. Don't waste time looking for sod. bic. Use warm water. Where did No. 3 get to? She was not seen after the first two minutes. One fair competitor made her entree tripping across tbe stage like a ballet dancer. 'I note that the tongue obstructs' said one competitor, but , although the pat!ent was supine, no attempt was made to relteve the condition.

Gas Industry Treatment of shock . What was the temperature of the kitchen? Why were the hot-water bottles moved so many times ? Once in position, let them remain. What a pity the' nuisance' has not been employed so much this year. This unexpected and irritating interruption doe~ test the tact and psychology of the competItors. Why not cover the burn m:mediately instead of waiting for a dreSSing to be prepared? The average housewife does not know what soda bie. or sodium bicarb. is. She only understands bicarbonate of soda. Why were the curtains drawn? It was not night-time. Is it not somewhat unusual to have a telephone in the kitchen? A barrel bandage can hardly be said to be the correct treatment for corrosive poison ing and a lacerated wrist!

G.P.O. Thejaw must be supported whilst bandage is being prepared and applied. Application of barrel bandage should be practised with patient in the recumbent position. Why did the team improvise so much when plenty ofF.A. material was available ? Entire absence of excitement gave one team considerable advantage. Was it necessary to lift the patient three times before the arrival of the ambulance? Always test the strength of the smelling salts. . Remove the cause' (bike) but make certain you are not aggravating any injuries in doing so. Pull, not push, in turning patient. Ring pads are not always firm enough. A loose ring is useless. Competitors will persist in palpating for fracture with the palm of the hand. Use the tips of fingers.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1954

Notes on advanced physiology By F. C. Reeve F.Z.S., F.R.E.S. THE NERVOUS SYSTEM (Continuedjrom Sept.jOct. issue) THERE are 31 pairs of these nerve trunks arising from the spina] cord, and they are named according to the region of the vertebral column from which they originate, viz. : 8 cervical, 12 dorsal, 5 lumbar, 5 sacral, I coccygeal. From the brain there are 12 pairs of nerves which have their origin in that organ, and they are numbered 1st cranial, 2nd cranial, etc. Some are sensory, some motor and some are mixed nerves, but in view of their relative importance it is necessary that the student should know the function of each as given on the right :AUTONOMIC NERVOUS SYSTEM There are certain activities of the body which are not under the control of the will, but continue day and night, asleep or awake, and even during unconsciousness, such as respiration, circulation, digestion, etc. These operations are governed by a separate set of nerves known as the autonomic nervous system, and is divided into two main subdivisions, viz., the sympathetic nervous system and the parasympathetic nervous system. Sympathetic Nervous System Although a separate system, there are, at least, some connections with the cerebro-spinal system, as will be seen. Arising from the grey matter in the centre of the spinal cord are fibres which connect with the two main sympathetic trunks, situated on either side and just in front of the vertebral column. Some of these fibres travel along the trunks for varying distances before bei ng relayed, and some are relayed immediately from the trunks to their respective destinations. Some leave the trunks from the medial (nearer the middle line), and some from the lateral (outer) side of each trunk. Those from the lateral side follow the paths taken by the spinal nerves of the C.N.S. to control those areas of skin, muscle, blood vessels and glands in the areas around the'

Name 1st Olfactory 2nd Optic 3rd Oculo-motor 4th Trochlear 5th Trigeminal

Type Sensory Sensory Motor Motor Mixed

6th Abducens 7th Facial ., 8th Auditory 9th Glosso-pharyngeal ... 10th Vagus ] 1th Spinal-accessory 12th Hypoglossal

Motor Motor Sensory Sensory Mixed Motor Motor

terminations of these nerves. Those leaving from the medial side serve to control the viscera in the thorax, abdomen and (a few) the head. Parasympathetic Nervous System These nerves serve as a brake on the activities of those of many of the sympathetic system, acting in many cases in opposition and thus helping to main t lin a nice balance. Although this subject, the Nervous System, is inexhaustible, sufficient has been written to illustrate its importance in co-ordinating the movements of the body and regulating those vital activities necessary to its continued existence. (VI) THE DIGESTIVE SYSTEM By the time that this number is in the hands of the readers many divisions and detachments will be partly through another course of Home Nursing and will just be arriving at the chapter dealing with diet. Oh! th.ose proteins, carbohydrates, fats, mll1eral salts and vitamins! How often have I heard the exclamation 'I hope I shall not be asked any questions on food.' This chapter in the Nursing manuals is I think, what the chapter on Poison~ is in the First Aid manuals the , great nightmare.' Any attem'pt to learn the essential points of this chapter parrot-fashion must necessarily prove a great strain on the memory, but a better knowledge of the proce~ses of digestion would, I am certam, make all the difference

Function Smell. Sight. Muscles of the eye. Muscles of the lip. Sensory to parts of eyeball, nose and tongue. Motor to chewing muscles. Muscles of the eye. Muscles of the face (expression). Hearing. Tongue (taste) and pharynx. Respiration, digestion. Pharynx. Muscles of tongue.

by enabling the student to understand the proper function of each of these ingredients of diet. Every . movement of the body, whether It be the contraction of a mus~le, the beating of the heart, the respIratory movement of the lungs, the passage of an impulse along a nerve trunk or even the reflex action of the brain itself demands an e~penditure of energy. This expendIture of energy must result in the breaking-down of tissues and if life is to be maintained, this ~ust be. b.alanced by a corresponding bUlldmg-up of the same tissues. There are, therefore, two separate and opposing actions to which the tissues of a living body are subject, and they are called respectively katabolism (breaking-down) and an~bolism (building-up), the two bell1g called collectively metabolism. The material required to replace the wear ~nd tear and, also, to increase the tlssues (growth) is obtained from the food which is consumed, but, obviously, it must be converted into a form in which it can be assimilated by these tissues. This process of conversion, therefore, we know as digestion, and the nurse who has made a study of the processes which constitute digestion will then better understand the reasons for the various diets which she will be called upon to provide ror the different patients, especially III the medical ward. (continued on page 12)

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From the time that food is taken into the mouth to the time that the waste residue is evacuated by the anus the food undergoes many changes, each change taking place within a definite section of the alimentary canal through which the food passes. Some knowledge of the anatomy of this channel will be necessary as a prelude to the study of the physiology of digestion, although a very brief description will be quite sufficient at this stage. The mouth, which contains the tongue and teeth, both of which perform very important functions, as will be seen later, opens into the pharynx, or throat, at the back of the tongue, and is common to both the respiratory and digestive systems. It is 5 in. long and divided into three sections, the nasal pharynx at the level of the nose, and which need not concern us in studying digestion, the oral pharynx beneath it, and the laryngeal pharynx behind the thyroid cartilage, or Adam's apple. Just below the thyroid cartilage, but not quite so prominent, is the crinoid cartilage, and at the level of this the pharynx joins the oesophagus, or gullet. This is a strong muscular tube, about 9 in. long, and lined with mucous membrane. Passing through an opening in the diaphragm the oesophagus enters the stomach, an organ like a dilated sausage bent illto a half-circle but with the lower end narrow and tapering. Its position is rather to the left, immediately under the diaphragm, but the position is liable to change, being governed by the amount of its contents at any given time and the position (standing or lying) of the individual. The upper portion, which receives the oesophagus,is called the fundus , whilst the lower part is known as the pylorus. The stomach empties into the small intestine, the upper portion of which is shaped Ii ke the letter C, and is known as the duodenum. The small intestine is a muscular tube between 20 and 22 ft. long, coiled up within the abdomen , the coils constantly changing position like a wriggling serpent. It terminates at the lower end of the abdomen on the right-hand side, where it enters the large intestine, or colon, at the ileo-caecal valve. The large intestine is a tube of a much larger calibre than the small intestine and is about 5 ft. long.

FIRST AID & NURSING, NOVEMBER /DECEMBER 1954

FlRST AID & NURSING, NOVEMBER/DECEMBER 1954

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DOWN 2. Holiday never taken alone 3. Every nurse can deal with this case 4. SUbject of infantile convulsions 5. Tuck these away neatly when bandaging 6. Cowardly or jaundiced 7. [n a fitting manner 8. Diurnal wandering of 20 9. Cholera, plague and malaria are endemic here J 4. Carries digested and absorbed food to the liver 18. Will help to control bleeding 19. Excretory process in which eating has a major part 23. Trritating 24.. Lie with limbs untidily outstretched 25 . Alleges without ale 26. Part of body in hea rt or soul 28. Good protein food often supplying fat a nd vitamins

(9) (6) (5,5) (4)

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SOLUTION TO CROSSWORD No.] 3 ACROSS 5, Stridor; 9, impacted; to, anaemia; II , sickness; 12, titular; 14, bowel ; 15, clot; J 6, Algid; 17, snipe; 18, cramp; 19, stun; 20, purrs; 22, toe-nail; 25, atropine; 26, win-over; 27, fracture ; 28, Tendons.

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FIRST AID & NURSING, NOVEMBER/DECEMBER 1954

Readers~

queries Answered by

Dr. A. D. Belilios

Mercury for Finding a Body in Water G. W. E. (Mansfield) writes :In reply to T. H. H. of Newark, whose letter I read in 'First Aid & Nursing' for fuly jAugust 1954, page 12, I am going to set his mind at rest about being called a fool. I saw this method used in about 1922. M y mother, who then attended spiritual meetings, came home one night and told us that the medium had stated that the body of a woman, who had been missing for some time, was lying in a pond, and arrangements had been made to try the local pond with the bread and mercury method. I was allowed to go after some persuasion, but I was told to keep out of the way . They took a loaf of bread, and partly breaking it open, pressed the mercury just in the top. Then they sent it floating on the pond. The method was quite unsuccessful, the reason being simply that the body was not there-it wasfound in another pond a little distance away!

F. H. B. (Vancouver) writes :I read with intense interest your excellent articles in your magazine 'First Aid & NurSing,' especially those on Diagnosis and Advanced Physiology and Anatomy. Having been an active member of the St. fohn Ambulance Association since 1905 and a certified Instructor for thirty years in this City and District of North Vancouver I would like to ask this question-' What is the force expended on the contraction of the left ventricle expressed in pounds pressure per square inch' ? I am frequently asked this question by shipyard workers and others when dealing with the circulatory system. I may add that I referred this question to the Metropolitan Insurance Company of New York but was informed

that they could not answer it. Would you, therefore, be kind enough to hand it to Dr. Belilios please. Also tell him how much we appreciate his excellent book on First Aid and holV eagerly we are looking forward to th.e nelV edition which we understand IS nOltl in preparation. Answer Many thanks for your kind remarks. I have repeatedly stressed when teaching, and in articles, that no first-aider should ever attempt to exceed his limitations. I, too, have my limitations, and any attempt to answer your question would be exceeding them. I suggest you make contact with a friendly Physiological Department of a University. Sorry not to be more helpful.

J. M. (Quebec) writes : Once again we are calling upon you to help to furth er our knowledge by knowing the why's and wherefore's of our first aid manual. Question No. I.- What is the function of the floating ribs, and why are they so called. We presume they are called this name, because they are unattached in Font, but do they actually move. Question No. 2.- It tells us that Insensibility is a loss of consciousness due to an interruption of the action of the brain, lvhich is brought about by some inte/jerence with the functions of the nervous system. Could you kindly clarify briefly what is meant by the above. Answer Another welcome enquiry from Canada-greetings! The last two false ribs are called free or floating ribs because their costal cartilages stand clear of each other and also the tenth. They only move slightly and their function is mainly protective. With regard to your second question, the definition given is neat and scientific but I can understand your difficulty. Since the brain is the seat of consciousness and also the main organ of the nervous system, it follows that if this system fails to work properly unconsciousness may result. The word 'some' is of importance because not all interferences cause loss of consciousness. Thus a tumour of the brain, at any rate in its early phases, does not cause unconsciousness although it

FIRST AID & NURSING, NOVEMBER/DECEMBER 1954

may produce other signs of interference, e.g., vomiting, paralysis, etc.

IRON BY MOUTH

C. W. H. (Norwich) writes : As an interested reader of First Aid & Nursing I note in the statement on the treating of Burns and Scalds (Sept.jOct. issue, 1954) that the burns or scalds, if on hand, foot or lower leg may be held under the cold water tap to relieve the pain pending professional treatment. Nothing should be put on except sterile (or absolutely clean) dressings. I have always been under the impression that burns or scalds should never be treated by cold water from the tap (which is not sterile) Would you kindly let me know in the next issue of 'First Aid' if this is the modern recognized treatment for the future. Answer We must appreciate that for many ailments and accidents there are alternative methods of treatment and this applies particularly in first aid for burns. Most first aid teachers now recommend the S.J.A.A. methods, only applying wet dressings when medical aid is not readily available, but we must not condemn a Ministry of Health Advice Note. Although tap water is not sterile, it does not usually contain harmful germs at any rate in our towns and cities. Obviously the main water tap should be used if possible.

W. P. J. (Seaford) writes : Page 182 ' First Aid to the Injured.' Frost Bite. It is stressed that the patient must not be taken into a warm atmosphere until circulation is restored. Would this cause a type of gangrene? Surely it is almost impossible to restore circulation out of doors in such cold weather and would it not expose the patient to further frostbUe (f he is kept out in the open. Answer There is in fact danger of gangrene in the affected part if the precautions recommended are not observed. Nevertheless treatment of the patient himself is of great importance and when he is taken to shelter, general principles of first aid should be applied provided that the affected parts are kept relatively cool.

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Answer

Readers' Queries (continued)

R. C. (Newport) writes :On 4th September my father, as he lVas finishing his nights' work at the collier)" slipped on a rail, striking his head 011 the left temple as he fell. The first-aid man was called immediately, and he found my father to be unconscious and gasping. He was taken to the surface and upon reaching it, it !Vas found that he had passed alVa),. At the inquest it llias said that death was caused by a Coronary Occlusion, but it was not explained to us lVhat a Coronary Occlusion is. We lvould be grateful if you lVould explain this to us and also if the blolV on the head contributed towards death. We also wondered (f a deep wound above the left eye, also sustained underground, ll'hich healed very quickly, could have in any way had an effect upon it. The wound lVas sustained around the early part of July. My father had been a reader of , First Aid & Nursing' for very man)' years, and had on occasions written for advice on first aid problems. He lVas Superintendent of the Oakdale Division S.J.A.B. , of which he had been a member of 35 years.

Deepest sympathies to you and your family on the loss of your father who had put in such good work for the S.l.A.B. Coronary occlusion means that the one or more of the chief blood vessels of the heart have become closed to such an extent that insufficient blood reaches the cardiac muscle to maintain its action. This is often due to the sudden formation of a clot of blood in the blood vessels - coronary thrombosis. It is not always fatalindeed many patients live for years after an attack. It is unlikely that the causes that you mention played any part in the catastrophe. J. B. (Gt. Yarmouth) writes :I hear that Aureomycin-the new lVonder drug-has been generally released and we can obtain it from our own doctors. For what ailments is it of value and has it any disadvantages. Answer

Yes, Aureomyci n is now generally available and is of value in a number of ailmen ts such as certain varieties of pneumonia, severe infections with

the germs called staphylococci and other rarer diseases such as parrot fever. Many other claims are made for the drug such as its value in Whooping cough and infantile D and V., but it is too early to make rash promises. Its administration may carry disadvantages caUed 'side effects' e.g., nausea, vomiting and diarrhoea. Incidently the drug is very expensive, costi ng over £2 for three days treatment.

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No. 704. Vol LX

A coachbuilt ambulance on a Karrier chassis

JANUARY/FEBRUARY 1955

are primarily caused by Staphylococci, Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms.

SKIN

THIS newly designed ambulance has accommodation for 2 stretcher patients, and the offside locker is convertible to accommodate four sitting patients facing forward. These seats are qUickly removable r,efore the carriage of an infectious case, thus rendering fumigation of the interior a quick and simple operation.

INFECTIONS

ANTIPEOL CUTANEOUS OINTMENT is a prepara-

tion which incorporates the sterile broth filtrates of the three infective microbes in an ointment base of proved efficiency further to accelerate the process of rapid healing.

This ambulance is fitted with a wash basin, and tip-up attendant's seat.

TREATMENT

for burns and scalds,

ANTIPEOL OINTMENT is both non-adhesive and

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ANTIPEOL is therefore an essential component of every First Aid and Nursing Kit.

FIRST AID & NURSING, JANUARY/FEBRUARY 1955 (

; Get in touch with us for - -

& Editor: Peter I. Craddock

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This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.C.2, for the purpose of providing an informative technical service on first aid and nursing. We welcome contributions.

January/February 1955

In this Issue Artificial Respiration ContraIndicated Musical Nurses Unconsciousness 2 Book Reviews... 3 Notes on Advanced Physiology 4 Casualties Union 5 Sussex Open Competition Metropolitan Police Competition ... Ealing Open Competition From a Seat in the Audience

Aid for the Brigade

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Artificial Bespiration Contra-Indicated

Nursing

SURGICAL BANDAGES, DRESSINGS, LiNT, COTTON WOOL and all F~rst Aid Requisites

TROUS

First Aid

"",1

News and Notes First-aider's crossword Readers' Queries

6 7 8

ONE of the items of "Do You Know That" feature in the last number of "First Aid and Nursing" has awakened considerable interest. It was the one in which it was stated that" artificial respiration should never be performed in the case of asphyxia caused by fumes from nitric acid, carbontetrachloride or trichlorethylene (trilene.)" The condition produced by these fumes is primarily anaesthesia not asphyxia, although asphyxia' does usually follow as a secondary sequel. The direct effect is, first, excitation then paresis and, finally, complet~ paralysis of the central nervous system as a result of the gases being conveyed by the blood corpuscles to the nervous centres situated in the medulla oblongata. As a result of the initial excitation the force of the heart-beat is increased, and this is accompanied by a slightly higher blood-pressure and powerful contraction of the muscles sufficient to fix the thorax, and it is in view of this spasticity of the chest muscles that artificial respiration is contra-indicated. Apart from the

usual steps to counteract shock the treatment of th1s condition is far beyond the scope of the first-aider, and it is essential that the patient be sent to casualty without a moment's delay, as it is a case for the theatre. Indeed, the need for immediate medical treatment is so urgent that the patient should be put on the first vehicle available instead of waiting for the ambulance. He should be accompanied on the journey by a skilled first-aider who should ensure that all tight clothing is loosened and particularly keep constant observation on the tongue to prevent it from slipping back and obstructing the air passages. One more important point, although competition teams are frequently criticised for making unnecessary 'phone calls to hospital, in a case such as this, casualty should be advised by 'phone which will enable preparations to be made, everything else being set aside. It will probably be found that the medical superintendent will be waiting for the case as well as the casualty officer.

12 14

Do you know that • •• 1. Most of the body tissues contain at least 75 % water ? 2. Coloured races can usually tolerate larger doses of most drugs than whites? 3. Any person in attendance at a birth must give notice of such birth to the Medical Officer within 36 hours. 4. A calorie is the amount of heat capable of raising the temperature of 1 kilogramme of water 1 deg. Cent ? 5. D.D.T. (dichloro-diphenyl-trichloroethane) was first manufactured by the German scientist Othmar Zeidler in 1873 ? 6. Koplik's spots are named after Henry Koplik (1858-1927,) the New York pediatrician, who described them in 1896, although they had been described the previous year by Nil Feodorowich Filotow (1847-1902) of Moscow?

Afusical }Vurses pASSING along a street in the shadow of Brighton's famolls Dome a few evenings before Christmas our ear caught the sound of carols. Nothing extraordinary about that, perhaps, but in this case they did not emanate from raucous-voiced urchins demanding that we should listen to the herald angels singing or defiantly asserting their iotention of awakening all Christians within earshot. No, we were listening to a well-trained choir of women's voices. Our curiosity was aroused, and we crossed the road to investigate, despite the fact that it resulted in our parting with the last loose coin we happened to have in our purse, and discovered the singers in the familiar uniform of the British Red Cross Society. It was the Women's Choir of Sussex 114 (Hove). This choir was formed two years

ago under the conductorship of Miss Blanche Cregan , L.R.A.M., L.T. c.L. , a well-known local music teacher, and is now an established institution in the district. Chatting with the Commandant, Mrs. M. Harvey, we learned that the object of the choir is to bring a ray of sunshine to the inhabitants of the various Old People's Homes in the area. These are visited in turn by the choir who, together with soloists, provide most enjoyable concerts. The choir is entirely self-supporting, giving occasional public concerts in order to provide the funds necessary for the purchase of music etc. The high standard of these concerts we are able to vouch for, as we had the privilege of attending the first one given by the choir two years ago. We feel sure that readers will wish them God speed.

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

COURSE IN ELEMENTARY FIRST

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

AID

The symptoms and signs are both general and local. Thus at the seat of injury, swelling, bruising, deformity and irregularity will often be found while often there will be a scalp wound leading down to the fracture. The general characteristics are usually those of shock combined with compression of the brain. At first the appearances are those of concussion and are later followed by those of compression. It will be readily understood that a depressed fracture is particularly liable to cause compression.

Unconsciousness By A. D. Belilios M.B., B.S. (Lond.), D.P.R. (Eng.) HEAD INJURIES HE last article in this series was devoted to the causes and general principles of unconsciousness. This month the important group of causes commonly known as the head injuries will be discussed. The head injuries include concussion and compression of the brain and also fractures of the skull. There are, of course, other injuries which affect the head but which do not come strictly within the scope of first aid while scalp wounds are more properly considered under wounds in general, already described in a preyious article.

Concussion of the Brain This common condition follows a blow on the head and is usually attributed to a ' shaking up' of the brain. It may last for any length of time from a 'split second' up to thirty minutes. When, however, the patient is unconscious for longer than half-an-hour the firstaider must always suspect that an injury more serious than concussion has taken place. In the mild cases, the patient may hardly be unconscious at all. He may see' stars' after receiving the blow on his head and for some time afterwards feel shaky and sick. Sometimes he loses consciousness for a few seconds but quickly recovers. In more severe cases, there is s~upor or coma accompanied by the sIgns of shock. In addition the first-aider must be prepared to recognise any of the following as characteristics of concussion. 1. The pupils are variable in size .but generally small; they react to light except in the severe cases when they are dilated and fixed. ~ut t~e pupils are always equal in sIz.e ; if unequal, it is almost positive eVIdence that an injury more serious than concussion has taken place. 2. Nausea ~nd vomiting are very common partlcularly during the stage ~f recovery and may last for some tIme.

3. The memory of the patient is affected. Often, on recovery, he is not only mentally confused, taking but little interest in his surroundings, but -is unable to remember the sequence of events that led up to the accident. The loss of memory may be permanent. This loss of memory, called retrograde amnesia in technical language, is a very important characteristic and whenever a first-aider is confronted with a patient in whom there is a suspicion of a head injury, memory must always be tested. An example is of interest. A boy arrived home late one evening in a dishevelled state and was unable to give his parents any account of his movements. Enquires revealed that he was out cycling with a school friend when he had a skid and hit his head against a lamp post. He was only unconscious for a few seconds and then remounted his bicycle, travelling for a short distance with his friend until their ways parted. The patient was not only unable to remember the accident but his movements afterwards until his arrival home. Lack of interest, headache and a general feeling of being' washed out,' may last for several days after the accident, depending of course on its severity. The patient may then appear perfectly normal but this does not mean that he is not in need of medical attention which will be described later. First Aid The immediate treatment of a concussed patient is that of shock removing him to shelter wher~ complete rest can be 0 btained. All the general principles described in the .last article should be applied, partlcularlyobservation. Sleep should be encouraged. A doctor is required to confirm the diagnosis and to exclude the possibility of complications. His advice may sound somewhat drastic since he may recommend that the patient be kept resting in bed for

some days. The length of time that rest is required is sometimes roughly estimated by allowing two days in bed for every minute that the patient was deeply unconscious. Rebellion against this advice is not uncommon by many patients who after the first few days feel normal and desire to resume their normal routine. It is, however, very important that the doctor's advice should be followed since there is a risk of complications in the future such as recurrent headaches and indeed some degree of mental impairment.

(

Fractures of the Cranium The cranium or ' brain box' as it is sometimes called is the upper part of the skull and does not include the bones that form the face or the lower jaw which itself is a separate bone. The cranium can be likened to a round hat box and has therefore six sides which, however, are rounded as they merge into each other. Thus there is the roof or vault of the skull as it is usually called, a front, back and sides all of which can be given technical names if desired. The base or floor of the cranium is a most important part. It is like a platform within the skull itself dividing the cranium from the bones of the face, mouth etc. Its surface marking approximately corresponds with the line drawn from the upper part of the orbit, through the ear to the back of the skull. There are numerous openings in the base of the skull through which nerves and bloodvessels pass during their course to and from the brain. Fractures of the Vault and sides Fractures of the cranium may affect any of the parts described. If they occur on the vault or sides, they are usually caused by direct violence such as a blow on the head and may be of any of the usual varieties-simple, compound, complicated, etc. An important type is called a despressed fracture when one of the fragments is pressed inwards towards the brain.

Fractured Base A fractured base of the skull is a common lllJury. It is generally caused by indirect violence such as a fall on to the vault as may occur when taking a 'header' over the handle bars or into shallow water when diving. Indirect violence is also the cause when a patient falls from a height on to his feet or in a sitting position in which event the force is transmitted up the spine. The symptoms and signs are not difficult to work out if the first-aider can visualise the situation of the base of the skull and its relationship to other organs in the vicinity e.g. the eyes, nose, mouth and ears. Eye signs include inequality of the pupils, a black eye and bleeding into the white of this organ; sometimes there will be a squint i.e. one eye turning inwards or outwards.

'The Health Visitor and Tuberculosis,' by S. H. Buchanan, S.R.N., S.C.M., H.V. Cert., N.A.P.T., Tavistock House North, Tavistock Square, London, W.C.1. Price 8s. 6d. (Two dollars.) This book is the final answer to those who contend that health visitors are not sociologists and should leave that side of their work to ' social workers.' The author shows how the tuberculosis health visitor can playa key part in the fight against tuberculosis. , Artificial Respiration' by T. O. Jarland, M.A., M.D., D.P.H. Faber & Faber Ltd., 24 Russell Square, London. Price 6s. 6d. Anyone may, at some time or another, be faced with an emergency when only artificial respiration, applied immediately can save a person's life. Dr. Jarland explains the principles of the subject and many photographs show the reader the different methods that can be used and also exactly what should be done in various situations. 'Simplified Diabetic Management' by J. T. Beardwood, J.R., A.B., M.D., F.A.C.P. and H. T. Kelly, M.D., F.A.C.P. Pitman Medical Publishing Co., Ltd., and J. B.

Nose-bleeding is not uncommon and may be accompanied by a discharge of pale water fluid-the cerebro-spinal fluid which surrounds the brain. Similarly blood and cerebro-spinal fluid may discharge from the ear if the drum of this organ has been torn. Bleeding from the mouth may also occur but often this blood is swallowed and subsequently vomited. Not all these signs are observed in every case; their presence naturally depends on the situation of the fracture. Hence the first-aider must not hesitate to diagnose a fractured base if the history is suspicious and one or more of the characteristics above described are noticed. Another point which must be emphasized is that the patient is not always unconscious although he will generally show some signs of shock. The writer of this article recalls the case of a little boy who ran into the side of his car bumping his head violently. The only sign was bleeding from the ear- the boy was quite conscious and very anxious to run home to his parents. First aid knowledge, however, dictated calling an ambulance and sending the child to hospital where an X-ray proved the fractured base. First Aid Fractures of the cranium are best treated in hospital where the patient can be kept under careful observa-

Lippincott Company, Philadelphia, U.S.A. Price 24s. The new sixth edition of this guidebook has been completely reVIsed and reset to incorporate all the latest advances in the case of the diabetic individual. , The Modern Treatment Yearbook 1955,' edited by Sir Cecil Wakeley, Bt., K.B.E., C.B., LL.D., M.Ch., D.Se., F.R.C.S. Bailliere, Tindall & Cox, Publishers, 7-8 Henrietta Street, Covent Garden London, W.C.2. Price 25s. The twenty-first issue of this well-known annual, published for The Medical Press. The thirty-six chapters cover a WIde range of subjects, and are designed .to enable t.he General Practitioner to keep ill touch With the latest advances in diagnosis and treatment. This year a special anniversary binding and jacket draw attention to the yearbook's . comin~ of. age,' and an attractive prospectus IS avaIlable on request in limited quantities for distribution. , A Therapeutic Index,' by C. M. Miller, M.D., M.R.C.P., Consultant Physician, Sefton General Hospital, Liverpool, and B. K. Ellenbogen, M.D., M.R.C.P., Senior Medical Registrar, Royal Southern Hospital,

tion and where there are facilities for dealing immediately with any emergency that may arise. Thus, if in fractures of the vault and sides of the skull, signs of compression make their appearance, an operation may be urgently required to relieve pressure on the brain. In the interval before removal, the first-aider can do little more than treat shock and apply the general principles for all cases of unconssiousness as described in the preceding article. A scalp wound should be covered with a light dressing and similarly the ear when there is any discharge. No attempt should be made at more ambitious treatment such as cleaning the wound for fear of carrying infection inwards. Compression of the Brain This has been left to the end since its symptoms and signs are very similar to cerebral haemorrhage which will be described in the next issue. It is caused by pressure on the brain resulting from a depressed fracture or from bleeding within the skull from the bloodvessels which surround the brain. The first signs of this head injury are those of concussion but later those of compression follow; sometimes the patient recovers consciousness for a short interval between the two conditions.

Liverpool. With a Foreword by E.. Noble PublIshers: Chamberlain, M.D., M.Sc. Bailliere, Tindall & Cox, 7-8 Henrietta Street, Covent Garden, London, W.C.2. Priee 12s. 6d. This new book is a suitable for all 4th and 5th year medical students. and ~or every newly .qualified do~tor. It IS a qUIck alphabetical reference gUIde to the treatment of all comm::m and many less common disorders and diseases. It also contains details of conunon practical procedures, useful diets, tables of dosage, etc. 'The Technique of Psycho-Analysis, ' by Edward Glover, M.D., M.B., Ch.B. Publishers: Bailliere, Tindall & Cox, 7-8 Henrietta Street, Covent Garden, London, W.C.2. Price 35s. This important book is stated to be the only work of its kind. The first section (more than half the book) contains fifteen chapters on psycho-analytical technique ; th~ seco~d part contains the results of a .questlOn~alre research into common technIcal pract~ces, with a detailed commentary and evaluatIOn; while the third part contains clinical and theoretical papers on technique.

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

Notes on advanced physiology By F. C. Reeve F.Z.S., F.R.E.S. THE DIGESTIVE SYSTEM (Continuedfrom the Nov./Dec. issue)

(the colon) is divided. into thr.ee I T sections. Commencmg at Its junction with the small intestine it passes upwards on the ri~h~ side as the ascending colon untIl It meets the diaphragm, where it changes direction and runs along under the diaphragm to the left side of the body. This portion is known as the transverse colon. The third section, the descending colon, then passes down the left side and eventually connects with the anal canal. The illustrations in the S.l.A.A. First Aid and Nursing manuals and the B.R.C.S. First Aid manual will help you to follow the above description. This, then, is a bare outline of the anatomy of the alimentary canal, bu t more details of its structure and of its accessories will be learned in studying the physiology of the system. Perhaps we cannot do better than assume that we are seated at lunch and have taken into the mouth a portion of food from the plate consisting of a piece of lean meat with some fat attached, some potato and green vegetables, and the whole flavoured with a pinch of salt. The reason for using this combination as an example is because it contains all the ingrediants of a balanced diet, proteins, carbohydrates, fats, mineral salts, vitamins, roughage and water. It may be thought that the processes which take place in the mouth, biting, chewing and, finally, swallowing, constitute the least important of all the digestive processes. On the contrary, it would be nearer the truth if they were to be regarded as the most important. Like most of our food, the combination we have taken as an example is solid, and the first process which it undergoes is a purely mechanical one. It must be broken up into much smaller pieces, and this is done by the teeth. A more detailed examination of these reveals a number of interesting points. In the mature adult there are 32 teeth, 16 in the

upper jaw and 16 in the lower, and they are of three distinct types. Commencing from the centre we find on each side two teeth, the incisors, the tops, or crowns, chiselshaped, and these are for biting off portions of a convenient size from a larger piece. Next to these on each side of the jaw we find a solitary tooth bearing no relation in appearance to its neighbours. It is called the canine tooth, and is reminiscent of a time when man's habits were far more savage than they are to-day, when he fought for his prey and tore it to pieces with these fangs as do the members of the dog family. Governed by the natural law of use and disuse, this tooth is rapidly becoming vestigial in man, and in the course of ages will probably disappear altogether. It is, however, worth careful examination and comparison. The crown is long and pointed as, in the dog, and was ideally suited for tearing flesh to pieces. It is now only slightly longer than its neighbours, but in past ages it must have been much longer as in the dog family. Following the canine there are five teeth with broad, flat crowns which are used for pounding or grinding the food into a pulp, although there is a slight difference between the first two and the next three. The crowns of the first two, the pre-molars, are each divided into two areas by a narrow channel, from which they derive their alternative name of bicuspids. The crowns of the last three, the molars, are much broader. By means of the teeth, therefore, the food is not only bitten into small pieces but it is also ground to a pulp in order to facilitate the chemical processes that complete the changes which the food undergoes before it is swallowed. Of all the food ingredients enumerated above, only the carbohydrates, found in potato, bread, rice, tapioca, corn flour, semolina, macaroni, oatmeal, barley, haricot beans, peas, vegetable marrow, parsnips, etc. (starches) ; dried fruit, beetroot, cane sugar, milk sugar,

glucose, maize stem, malted barley, carrots, etc. (sugars) are acted upon in the mouth. Starch consists of minute granules, each of which is enclosed in an envelope or capsule, and digestion of starch cannot commence until these capsules have been ruptured, thus freeing the contents. This is effected by heating, which causes the contents to swell and burst the capsule, hence the necessity of cooking all starchy foods. Digestion really commences when the starch granules are brought into contact with the saliva, which contains an enzyme, or ferment, called ptyalin, and which exerts a chemical action by breaking down the starch into dextrin and maltose, which are forms of sugar, this being the only form in which the carbohydrates can be absorbed through the mucous membrane of the alimentary canal. Where, however, does the saliva come from? It is produced (secreted, to use the correct term) from the blood in the vessels surrounding three pairs of glands, or pockets, in the mucous membrane of the mouth, each gland opening by a tiny duct, or channel, on to the surface of this mucous membrane. The ceUs of which the glands are composed possess the power of extracting from the blood fluid certain substances which are manufactured by them into saliva. There are three pairs of these glands, the first, the parotid, being situated, one on each side, just in front of the ear and behind the angle of the jaw. Each of the next pair of glands, the submaxillary, lies under the jaw on either side, the duct opening under the tongue. The sublingual glands, as the name implies, lie under the tongue and open on to the surface by a number of tiny ducts. There are, however, in addition to the salivary glands, a number of small glands scattered over the surface of the mucous membrane of the mouth which secrete mucus, a slimy, viscid substance which becomes worked into the food mass and assists it to slide easily over the tongue and into the pharynx when the time comes.

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

It must not be imagined that the saliva is flowing continuously. It only flows when it is required, and here we find a very wonderful provision of nature. There are many phenomena which ~ave the effect of stimulating appetIte, such as the sight, smell and even the thought of food, especially if.it be of a palatable nature. You WIll remember that, when dealing with the nervous system in the Sept.jOct. number (I hope readers file their copies for reference so that this article, and also the very excellent one by Dr. Belilios, may be regarded. as . text-books) I explained that stImuli are trans-

mitted from the surface of the body to . the brain by nervous impUlses which are immediately responded to by spontaneous action. Here, then, we find a similar reflex action. So delicate are the receptive powers of the nerve-endings in the mouth that they are capable of stimulation by even the sight, taste, smell or thought of food, and the nervous impulses are transmitted by the different fibres of the 5th and 9th nerves (refer to the table in the Nov./ Dec. number) to the salivary centre in the pons. The reflex action is then completed when the motor nerves transmit the impulses to the glands,

which immediately commence to secrete a fresh supply of saliva. They do more than this, however, for at the same time the blood-vessels from which the saliva is manufactured become dilated, thus making available an increased flow of blood for the purpose. When the food has been thoroughly masticated, mixed with saliva and collected into a ball, or , bolus' by the combined action of the to~gue, lips and cheeks, it is passed to the back of. the tongue and is ready for swallowmg. (To be continued)

CASU ~L\LTIES UNION Police win Newcastle-upon-Tyne Competition in Diagnosis. In response to many requests for practi ce in diagnosis in the north-east, Newcastle Branch staged an Open CompetitIOn. on Sunday 30th January, 1955. Twenty eIght teams ~ntered from Engineering Works CoUieries, Police, Mobile First Aid Units of N.H.S.R., Civil Defence, ~~. John Ambulance Brigade and The BntIsh Red Cross Society. The teams consisted of two members each of whom had to diagnose 6 .cases. Twelve different cases were staged 10 ~he 1st Northumberland General HOspItal (T.A.) Drill Hall by kind permission of the Commanding Officer, Colonel J. V,. Todd. R.A.M.e. also kindly provided the Judges. The Branch President Colonel R. Errington, e.B.E., M.e., T.D.,. Q.H.P., pre~en~ed the James Pilkington ShIeld to the WlDDl?g team Northumberland County Police , A ' 'team. Runners up were Newcastle City Police' A' team. Annual General Meeting The A.d.M. was held at the Artworkers Guildhall Queen's Square, London. W.e.l. on Saturday 29th January, 1955 when the Annual Report for the past year was presented and officers were elected for the coming year. H.L. Glyn Hughes C.B.E., D.S.O., M.e., Q.H.P., was re-elected Presiden~, supported by the following Vice-Presidents-The Lord· Rowallan, K.B.E., M.e. T.D., Wing Cdr. Sir J~~n H?dsoll, e.B., Mrs. R. F. Whiteley, PhIlip WIles, M.S., F.~.e.S. J. E. Raine, M.B., B.Ch., D.P.H., MaJ-Gen. L. A. Hawes, e.B.E., D.S.O., M.e., Lieut. Gen. Sir Otto Lund, K.e.B., D.S.O. The Annual Report revealed that six New Branches had been formed dunng. the year at Halifax; Norwich; Staffordslme; Norton Yorks' Eastbourne and London. Forty three Ndw Study Circles had also

been formed including Circles in CaIl:ada and South Africa. In answer to questions it was stated that four more New Branches had been formed by the up grading of Study Circles since the end of the year at Easingwold, Yorks; Slough, Bucks; Newbury Berks' and Lynedoch, Glasgow. Eight furthe; Study Circles had also been formed. The Record of Activities showed an increase of over 50% on the previous year, averaging more than 3 eveI?ts a day to/0ughout the year and ex~~edm~ 5 dunng the peak period competl tlOn tune. .A great many organisations had been aSSIsted but the main ones were St. John and Red Cross who accounted for approximately one third each. Civil Defence and N.H.S.R. accounted for one quarter and Industry one fifth. The events of national in~e:rest included National Miners Competlt~C?ns The Stanley Shield Contests for the Bntlsh Red Cross Society, The N H.~.R. Conte~ts and the Civil Defence TeleVised ExerCise , Riverside Operation.' The President expressed his pleas,ure at the growing interest being. shown 10 the work of the Union. He remmded m~mbers that the demand was lIkely to cootmue to increase and that the Union should press forward with training of new members and he hoped many more volunteers would come forward to share i~ the work. It was essential that the high standard of training should be maintained. He hoped that steps now being taken to ease the administrative burden on the offi~ers would enable them to give even more tl.me to training and the activities of the UniOn T he Chair was taken by Councillor H. Davies, the Chai~lan of the General Management CommIttee. The proceedings were followed by the Annual Social and Party run by the London Branch This was well supported and proved' to be a most enjoyable event. The

large proportion of members under 30 appeared to be significant. The M.e. was Mr. Dunbar of the London Ambulance Service, a member of London Branch. Cape Town Branch Cape Town Branch has had a full y~ar in which it was called upon to pr?Ylde patients for all the St. John Competitions in the Cape. They also assisted many .o~her .organi.sations but their most excltmg lDvltatlOn came from the South African Red Cross Society in conn~c~i?n with The Florence Nightingale Exhibition. Surgeons of the Groote Shuur Hospital wished to demo.nstrate the operation for removal of appen~lx. W. H. Behrens and T. E. DaVIS, deVised the necessary false build up of abdomen which bled satisfactorily when the surgeon made the incision and saturate~ a nurn~e~ of swabs. After removal of the app~ndlx the wound was success~ull~ stJtc~ed; T. E. Davis underwent thiS ope~a~lOn six times during the three day exhibition and the complete theatre tech01~ll-:e was The whole exhIbIt was demonstrated. arranged by Sister J. R . Urquart ?f t~e Groot Shuur Hospital. An interestlOg, If unusual, demand upon the members of Casualties Union. Buxton Trophy, 1955 Following upon the su.ccessfu,I exp~ri ment last year of hold 109 . elimlOatlOg rounds in the provinces, entnes .are .now invited for the 1955 contest which IS to be decided at Ponders End Gas Works, by kind permission of the Eastern G~s .Bo<l:rd, on Sunday 2nd October, 1955. E~mlOa.tlllg rounds will be held concurren tly lD vanous Regions on Sunday, 10th July, 1955. Copies of the Rules which haye been slightly amended can be obtalOed by sending stamped self-add.ressd enveloj),e to Miss E. E. Johnson, 8 Wooj:::ote ParI< Avenue) Purle>" Surrey

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

SUSSEX OPEN COMPETITION SUSSEX claims to be the first county to have organised open ambulance competitions, but it is hoped that the County of Lincolnshire will soon follow. On Sunday 21st November, ]954 last the Sussex Open First Aid Competition Association held their third Annual Competitions for the , Duke of Norfolk' Bowl, the' Van Dyck ' Trophy and the 'Puckert' Cup, at the Town Hall, Eastcourne, through the courtesy of the Mayor and Corporation of that famous seaside resort. We learn, with great interest, that the Competitions were inaugurated in 1952, and that it is unique in that, at present, it is the only one of this type in this country. The object is to further and improve the science of first aid amongst the public, and the organisations connected with it. In order to achieve this object it is open to all organisations practising first aid in the County of Sussex, and tbe variety of these organisations will be evident from the following list of teams which competed : Hastings Police, South Eastern Electricity Board, Eastbourne District, Southwick, S.J.A.B., Crawley S.J.A.B., Eastbourne S.J.A.B., British Railways, Brighton, Brighton Police' A ' Team, British Railways, Lancing' C ' Team, South Eastern Electricity Board, Hastings District, Eastbourne Police, Hilton Division, Hastings, S.J.A.B., Civil Defence Corps, Ambulance Section, Lewes, Worthing S.J.A.B., South Eastern Electricity Board, Worthing , A ' Team, East Sussex Police British Railways, Lancing' B ' Team, West Sussex Police, Brighton Power Station' B ' Team, Brighton Power Station' A ' Team. An unique feature of the team test was the fact that the setting represented an actual site near the town, the junction of Lewes main road with the HailshamEastbourne road, a spot well-known to all local residents. Here on a cold fine morning, a workman, ex~cuting repairs at the top of an electricity pylon is accidentally shot in the right leg by a r~stic sportsman and falls to the ground beside his mate who is standing below. As he falls he .grasps the live wire, carrying, as the notIce board states, 10,000 volts. Time allowed for the test, twelve minutes. pr. H. A. Tuck, of Shoreham, was the Judge. The practical test for numbers 2 and 3 was judged by Dr. S. R. Mathews of Crawley. It was simple and straightforward .. The two bearers have called upon M~. S.nuth who suddenly develops an epIleptic fit and falls forward into the fireplace .. ~o-one else is in the house. as Mrs. Smith IS out shopping. Oral tests were set for numbers 1 and 4 and were judged b>, Drs. W. H, McAleenan,

of Eastbourne, and K. N. Mawson, respectively. There were four questions altogether: (a) State the main groups of poisons giving

examples of each group; (b) Describe abdominal hernia and give the

treatment; What are the signs and symptoms of diabetic coma and insulin over-dose? Gi\'e the treatment for both; Cd) Describe the cerebral-spinal system. (c)

After the competitions, amid a rural setting of green fields and rustic fences, the Mayor of Eastbourne presided at the presentation ceremony, supported by the Mayoress, the Duke of Norfolk (president of the Association), Mrs .. E. W. Puckert, Mr. R. W. Walker (Chief Constable of Eastbourne), Dr. H. Rosenberg and judges. In extending a welcome to the Duke of Norfolk, who had kindly consented to present the trophies, he said that we had seen him on television, carrying out those very important tasks at the Coronation but we were now privileged to see and hea; him in person. Dr. Tuck, in response to the Chairman's invitation, proceeded to comment upon the team test. He emphasized the importance of removing further danger. Those teams who failed to disarm this careless, rustic sportsman, who should never have been trusted with a gun, had one of their men afterwards shot in the foot, thus losing 20 marks. He remarked that two or three competitors evidently did not know how to , break' a gUn. There was a further moralNever point a gun, even if you believe it to be unloaded. Some took precautions which were quite unnecessary, for the victim was then some distance from the cable, and his mate was actually touching him without being affected, This was a test of observation. He also pointed out that a fractured limb must be supported until it had been immobiJised. He reminded them that tea from a vacuum flask could be very hot but I?-ot one of the competitors attempted t~ test Its heat before administering it to the patient. Summing up, he congratulated the teams, saying that all had set about the test in a most businesslike manner.

Sgt. A. J. Griffin of Worthing, Captain of the West Sussex Police Team, receives the Duke of Norfolk Trophy. [Courtesy Eastbourne 6aze/tel

He was followed by Dr. Mathews, who commented upon the individual practical test. He remmded the competitors in this test that they were there all the time and saw everything. They really had very little to do. There was no need for hospitalisation or sending for the police. It was indeed a trivial .case. The treatment of bl~eding a~d breathmg was good. The first consideration in this test should have been the tongue gag. One the second, protection from fife. team merited criticism for thinking of themselves first. The patient must always come first. Dentures were not always removed, but, he warned, when they are removed, treat them carefully. One comp~titor threw th~. dentures on the ground. HIS final admollltlOn was a quotation from the B.R.e.S. text-book-' Do first things firs~.' He expressed his appreciation of the actmg of the' patient,' who had treated aLI teams alike. 'He feJl with abandon' commented Dr. Mathews. Next came the announcement of the results, which were as follows: 1.

2. 3. 4. 5. 6. 7.

8. 9. 10. ] 1. ]2.

13. 14. 15. 16. 17. 18. 19.

West Sussex Police British Railways, Lancing' Team... ... ... . .. Brighton Police' A' Team Eastbourne Police British Railways, Brighton '" British Railways, Lancing' C ' Team... '" '" ... Hastings Police Eastbourne S.J.A.B., ... East Sussex Police Brighton Power Station 'A' Team Southwick S.J.A.B., ... Hastings S.J.A.B., (Hilton Div.) South-Eastern Electricity Board Worthing' A' Team ... Brighton Power Station 'B' Team Worthing S.J.A.B. Crawley S.J.A.B. ... South-Eastern Electricity Board Hastings District ... . .. South-Eastern Electricity Board Eastbourne District Civil Defence Corps "'Amb~~ lance Section, Lewes ~.. ...

26 It

244t 244 241t 236 225

220! 215

210t 204t 199t 190t 188

178t 171t ]69 156

154t 100

FIRST AID & NURSING, JANUARY/FEBRUARY 1955 In responding to the invitation of the Mayor, His Grace, the Duke of Norfolk, with a handshake and a few kindly words to each competitor, then presented the trophies to the winning teams. Turning to the Mayor, he thanked him for the most enthusiastic welcome extended to him, and expressed the great pleasure he experienced in being there that afternoon. He congratulated the winners who had been successful and all the teams for the excellent work they had put in. We cannot overestimate the importance of as many as possible learning this valuable subject. He hoped to have the pleasure of being with them again next year.

In thanking His Grace the Mayor said that the Duke was a very busy gentleman, as they all knew, and they very much appreciated his presence, ' but' added the Mayor, ' I think he loves Eastbourne.' Dr. H. Rosenberg, in proposing a vote of thanks to the Mayor of Eastbourne, reminded his hearers that they had watched the Association grow from a very small beginning. Sussex had always distinguished itself in ambulance work owing to the help given by the officials of, not only the towns, but of the small villages. 'We do thank you, Mr. Mayor' he said' for your own very great interest in this work.' .He believed that the Competitions would be

Metropolitan Police 'yOUR policemen are wonderful' exclaim our foreign visitors- and, of course, they mean our policewomen as well-out they would say this with even greater enthusiasm if they could have seen some of the crack police first aid teams vieing with each other in the Parsons Shield and No. 9 District (Pim Trophy) Combined First Aid Competitions Final at Percy Laurie House, Putney, on Friday 28th January last. The ten teams competing represented A, F, G, J, L, M, Thames, V, Wand Z Divisions, and were the winners of the eliminating competitions in their respective divhions. Each team had to submit to a team test, a dual practical test, an individual practical test and oral questions, all of which were of a most interesting character. In the team test the members are passing a building site when they hear groans corning from a platform supported by scaffolding. Upon investigation they find that a workman has fallen and is lying on the stage suffering from lacerated wound of forehead with foreign body firmly embedded, concussion (stupor develops after 3 minutes), dislocation of jaw and simple fracture of right knee-cap. The test had been set with a view to testing the ingenuity of the teams, whose efforts were hampered by the very restricted space in which they were called upon to work. The test had been set, and was judged by, Dr. M. M. Scott, Deputy Surgeon-inChief of the St. John Ambulance Brigade. The scene of the dual practical test was set in the section house canteen where it was found that a customer had upset a large urn full of hot tea, scalding his left leg, dislocating his right elbow, and was also suffering from shock. Considerable amusement was created by the reveller who lurched across the stage singing and shouting in characteristic drunken fashion. He had to be dealt with by a single competitor, but whilst being tactfully restrained, he fell heavily to the ground, fracturing the base of his skull. His alcoholic condition had to be taken into account in treating. The three questions constituting the viva voce test had been very carefully thought out, and were: (a) How would you deal with a crush injury of a limb, with delay in rescue? (b) What type of shock would you expect tonnd in such a case ? c) What other causes of this type of shock do you know ? The viva voce and the two practical tests had been set, and were judged by, Dr. K. S. Maurice Smith.

held in West Sussex next year, but he hoped that the people of East Sussex would come over and enjoy themselves. After a round of the Sussex towns he hoped that the Competitions would again return to Eastbourne. The Mayor replied by repeating the pleasure it had given him and his colleagues to welcome them to Eastbourne. Votes of thanks to the stewards , patients,' the competition secretary, Chief Inspector G. M. Watkins, and all who had helped to make the day a success- especially the nurses of the Brigade who had assisted with the teas-brought to a close a most successful event.

~ompetitions

Perhaps the enthusiasm which has always been shown by the police in first aid is due in no small measure to the support which is given by the officials, and among others to be seen there that day were Capt. Rymer Jones, O.B.E., M.e., Assistant Commissioner; Miss E. e. Bather, O.B.E., Chief Superintendent, Women Police; Miss Yates, Superintendent, Women Police, No. 4 District and Miss E. Warrington, Matron of the Police Nursing Home, Denmark Hill. At 3.30 p.m. the large hall was prepared for the presentation ceremony, and on the long table were displayed the coveted trophies which had been competed for. In opening the proceedings Capt. Rymer Jones expressed the gratitude of all concerned to the judges who had officiated that day, and asked them if they would be good enough to comment upon what they had seen. Dr. Scott was the first speaker. He said that it was some vears since he had judged that particular competition, and he noted with pleasure the improvement in the standard of work. There had been times when he had not been quite so enthusiastic, but he had to confess that the standard of work they had seen that day was extremely fine. The winning team of that day's competition would be going forward to the final for the Pim Trophy. and the winner of that would then compete for the Grand Prior Trophy. It was with this in mind that he had set a test which he believed was of Grand Prior standard in order that they might realise what they were likely to be up against. Moreover, he said, he had not been merciful. He had judged that competition as he would have judged the Pim or the Grand Prior, and he believed that they would appreciate his action. The basis of the test had been one of action, for first aid is practical, and its essence is simplicity. The underlying idea in the team test had been that the patient was on a platform, in a most awkward position, in which it would have been impossible to give full treatment. The competitors were required to give the minimum of treatment on the platform, reserving completion of the treatment for a more convenient time. , Go for the part you know to be urgent' he advised, ' and don't forget to talk to the patient.' One point he wished to emphasize, and that was that competitors do not always recognize the full significance of asepsis. 'Thank you' he concluded 'for your patience with me, although privately you may be cursing me. However, I have enjoyed every minute, and thank: you for the privilege. '

Dr. Maurice Smith agreed with Dr. Scott that the standard of work had been very high, and because of this the marking had been low. In diagnosis they should pay particular attention to eyes and ears. In the case of the fractured base many had looked at the ears but had failed to note the escaping fluid, so diagnostic of this condition. All the teams had found the dislocation, but nearly all teams had bandaged the wrong place, mistaking some paint marks on the trousers for blood. Should it be necessary to have to wait for the ambulance they could not occupy the time better than by making the patient comfortable. He paid a high tribute to the , casualties' who had acted their parts well and had been most fair by treating all teams exactly alike. He concluded by advising them to 'read, mark, learn and inwardly digest' all that Dr. Scott had said, , but' he added, with a twinkle, 'I don't think you will ask me to judge again when you have seen the marking sheets. ' Captain Rymer Jones then announced the results as follows: (Maximum marks possible, 400.) 1. L Division 298 winning the Sir Hugh Turnbull Trophy. This team also tied with A Division in winning the Parsons Plaque offered for the highest aggregate of marks in the Individual Tests, (l25 } marks each.) 270 ~ 2. V Division 263t 3. J Division 260 4. A Division Tied with L Division for the Parsons Plaque (see above). 254 5. F Division 249 ~ 6. M Division 225~ 7. G Division 197t 8. Thames Division 182! 9. W and ZDivisions (tied) MIXED TEAM The Competition was unique in that it was the first in which a mixed team had entered. Chief Superintendent Miss Bather informed us that it was an e,<periment which was being watched with the greatest interest. A lady, P.C. Miss Chapman, was included in the 1:- Division team. Whether or not the expenment had proved a success will be evident from the results reported above. In presenting the Trophies to the successful teams Capt. Rymer Jones congratulate~, not only the winners, but all the competItors for the splendid performances which had been shown that day.

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

E~L\LING MORE than 500 people witnessed the Finals of the Ninth Ealing Open First Aid Competition, organised by No. 85 Ealing) Ambulance Division, and held at the Ealing Grammar School on Saturday, 11 th December. The guest of honour was Horace F. Parshall Esq., T.D., M.A., (Director General, St. John Ambulance Association) who when presenting the trophies and prizes complimented the Ealing Ambulance Division on organising a competition of such a high and efficiently organised standard. He hoped that other parts of the country would follow the lead given and provide opportunities for Brigade and Association teams to meet each other in competition work. Divisional Supt. G. L. Smith, in welcoming the many distinguished guests, stated that the entries were once again a record, despite the fact that they were again restricted to the Metropolitan Police Area. A total of 69 teams and 140 individuals had taken part in competing for the] 0 trophies. Two further trophies had been presented to the Division for this Competition, and would be for Cadets, making a total of 12 trophies for next year's Competition. He paid special tribute to two peopleJohn Gow, ""ho since the competition commenced in 1946 had arranged with Pinewood and Ealing Film Studios the various staging effects, and had personally arranged all the sets which were so effective and realistic. Secondly, Divisional Officer Derek R. Fenton, who for the ninth successive year had undertaken the task of organising the whole competition. The Finals were the culmination of nine months hard work.

OPEN COl'IPETITION

His Worship the Mayor of Ealing, AJderman Gooderhan1, extended a very warm welcome on behalf of the Borough to the many distinguished guests. He declared that Ealing was very proud of the St. John Ambulance Brigade, and he personally had seen the excellent effect of their training on sports fields throughout the Borough. Dr. G. R. H. Wrangham J. P. (Area Commissioner, Western Area) thanked H. Parshall and the Mayor for honouring the Competition with their presence. Before announcing the results, Divisional Officer Derek R. Fenton, gave his personal thanks to the 250 men and women who had given him such valuable assistance in both the preliminary and final rounds. Without this help it ""ould not be possible to organise a Competition of this size and ensure its smooth running. The competitions deserved every consideration, and all possible was done to eliminate unnecessary restrictions. The results were as follows:

Eating Challenge Cup 1. Greenford and Northolt Ambulance Division. 2. Ealing AmbuJance Division. 3. Harwell. Barclay Smith Cup 1. British Transport (London.)

Women

Police

Willoughby-Garner Cup 1. W. Division Metropolitan Police. Arthur Fenton Cup 1. Cricklewood Ambulance Division.

Caldwell Cup 1. Tottenham Gas Ambulance Division. Florence Cup 1. British Transport (London.)

Women

Police

Barnard Cup 1. Miss W. Police.)

(D.T.e.

Women

Barrett

Hill Cup 1. Miss. J. Daley (B.T.e. Women Police.) Brooks CliP 1. G. Kirkham (146 B. Rly. Camden.) Wrangham Cup 1. K. Curtis (B. Rlys. Wimbledon Park.) Amongst the many distinguished guests who witnessed the Competition in afternoon and evening were : Surgeon Rear Admiral S. G. Rainsford (Deputy Medical Director General of th~ Navy.) Surgeon Commander J. L. S. Coulter. Group Captain J. Dales, (Medical Dept. Air Ministry.) Lt. Col. e. Corfield, (ADMS. Eastern Command.) Lt. Col. Air E. D. H. Williams, (War Office.) Marshal Sir Harold Whittingham (Director of Medical Services B.O.A.c'.) Col. e. H. Bramlett, Major Paul King, Capt. Ravish, and Capt. Meltzer, 4.94th U.S.A.F. Hospital Ruislip. Col. N. Mc. K. Jesper (Chief of Police London Area B.T.e.) Col. G. F. Page (Commissioner No. 1 District.) Dr. G. M. Shaw Smith (Area Commissioner Northern Area.) There were also present many officers and members from all areas in No. 1 District.

• From a seat In the audience Some random and provocative comments on the competitions Sussex Open One competitor complained because he could not find a teaspoon ! , I note ':l burn on the right hand,' said the competitor. Well, why on earth didn't he get on with it ? . How. few remember to see if the patient IS weanng dentures. More. correct timing is required in perforrrung artificial respiration. Haemorrhage cannot be controlled through clothing. Some competitors imagine they are actors taking part in a drama instead of first aiders treating a patient. Make certain that you know your haversack. Why .was the mouth gag removed before convulsLons had ceased ? W~s .it necessary to spend so much time exammmg the burn before commencing treatment? What a clever little actress the judge's chanrung daughter proved. A ?ouple of drachms of water are not suffiCient to cover the hand.

How many men know how to ' break' a gun? Use of 'phone-either too much or too little. Use discretion. That femur came in for some pretty rough handling. Too much time is wasted before commencing artificial respiration. It is unnecessary to give the judge a technical description of a burn. He is waiting to see you treat it. Example of observation: The competitor who asked the sportsman if he had a flask of tea when there were two lying at his own feet. How came this rustic to possess a key to the R.A.F. box? In case taking don't · suggest possible Let his symptoms to your patient? answers be spontaneous. Mouth gag should be introduced without delay. Is not enquiring for the nearest 'phone becoming a fetish? There was an R.A.F. box a few yards away within sight.

When the diagnosis is obvious examination of pulse, temp., eyes etc. is unnecessary. Two teams 'phoned for doctor but omitted to state where he was required. Pity the competitor who could not make up his mind whether to 'phone the police or a doctor. Why waste time on the mate who was uninjured? There was a decided weakness on poisons. Why will trained first alders persist in calling the abdomen the stomach ? Several times the word' reflex' was used but how many could have. defined it ? ' Why was the competitor so anxious to learn if the patient was married? W~at is the correct technique for turning a patient? 'Is patient breathing ?'-Why not find out? Why not try a slap on the back to clear the airway? Those windows-they are nearly always forgotten.

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

It was obvious which teams had taken the Royal Life Saving Society'S course and which had not. Of all those who used the R.A.C. box I did not see one who signed the book. Three competitors were all calling to the mate at the same time. Don't forget the soothing effect of a cigarette. Metropolitan Police One team said 'Don't you \'lorry' nineteen times. Did the competitor who took the name and address of the patient before diagnosing or treating think he would peg out immediately ? Is it necessary to warn an experienced ambulance driver to drive carefully? Often too many persons were talking at once. Congratulations to P.C. Miss Chapman, the only woman in the whole Competition.

One leader addressed the members of his team by numbers. Did he really diagnose fractured patella through the thickness of the trousers or was it guesswork? What diagnosis was arrived at by the three competitors who all endeavoured to question the patient simultaneously ? Only too frequently do questions take the place of examination. It is of no use smothering the hands with antiseptic jf septic articles are handled immediately afterwards. Do, please, tuck those ends of bandages out of sight. Was the untrained bystander expected to remember all that ? 'I can't get any first aid equipment,' said the competitor. Why not improvise? In what extraordinary places and under what extraordinary circumstances are hot water bottles often expected to be found ?

The canteen manager could not assist as he had a double rupture. 'We'll deal with you in a moment' said the leader. Several noted the unequal pupils but failed to appreciate their significance. 'I'll cover the ear '-but he didn't. Some of the old stagers are so used to finding blankets provided that failme to do so throws them entirely out of their stride. 'Have you any ice in your pocket ?' asked a competitor. Isn't the use of a glass bottle as a substitute for a hot water bottle rather risky ? Where did he think a stream or a drinking fountain was coming from? Too many all wanting to do the same thing at the same time-lack of organization Why wheel the barrow about ? It was not in the way.

News and Notes Institute of Certified Ambulance Personnel THE following statement has been issued by the Council of the Institute to clarify their policy on refresher courses and the renewal of elementary first aid certificates. 1. This Institute does not organise, nor does it favour, refresher courses for ambulance personnel on the lines now carried out by some local authorities. Nor do we believe that it is a useful contribution to technical efficiency to require skilled personnel to take an elementary examination at stated intervals. These arrangements may have been necessary in the days when ambulance staffs were on a voluntary basis and were not carrying out ambulance duties each and every day and thus needed a test of skill from time to time, but l nder present arrangements they are no longer useful. 2. We consider that the examinations of the Institute cover the basic knowledge in such a way as to make refresher courses which deal with material of a more elementary nature, superfluous. In addition we feel that these courses appear to have the effect of keeping ambulance personnel at the ' recruits' stage since no allowance is made for experience and qualifications. In covering such general ground the courses do not encourage ambulance staffs to advance their knowledge.

3. We are not however opposed to the continuous training of ambulance personnel on all subjects which come within their field of work but we consider that this should be on a progressive basis and not cover the same ground year after year. 4. No other professional body requires its members to take refresher courses after they have gained their basic qualification and the practice of so doing appears to act as a deterrent to the adequate training of ambulance personnel. 5. This Institute wishes to see the training of ambulance personnel put on a standard basis with the Fellowship diploma of the Institute as the basic qualification. If this were accepted it would mean that ambulance personnel could be given training courses on subjects allied to their work which were of real worth and not a repetition of knowledge alreadv assimilated . Can You Beat This ? It was interesting to ]Jote on page 9, of the December issue, of the ' First Aid & Nursing,' in yom article, 'From a Seat in the Audience,' that a Mother and Daughter were in the same Team. I have great pleasure in stating that in The Ramsgate Railway Division, who were Kent Champions for 1953 & 1954, we have two fathers and two sons in the Team, Photo below. Ramsgate Railway Ambulance Class, 1954

Standing-D. Buckley, K. Lambert, V. Solly, G. W. Pointer, M. Taylor, T. Lehan, P. Lehan. Sitting-C. Buckley, E. Lambert, A. Solly, G. Pointer, B. Taylor, W. Corfe, J. Lehan, Mr. Corfe's Son on NationallService.

Also of interest, in our Southern Region Ambulance Centre, Ramsgate Class, we have four fathers & four sons, two fathers and two daughters, one father, one son and daughter, also two husbands and wives. Can you beat this record? Hoping you will find these details of some interest, also best wishes for the future of First Aid and Nursing for 1955. - Yours faithflll1y, G. Pointer (Div. Supt.). London Transport Ambulance Centre The presentation of First Aid Awards was held at the Porch ester Hall, Porchester Road, Bayswater, W.2. and was accompanied by a Dance, Social and Cabaret. The presentation was made by Mrs. B. H. Harbour, and some 350 out of 900 awards gained during the first half of 1954 were presented to members and were followed by special awards to the undermentioned : Long Service Awards 15 yea r medals East Ham (Rlys.) Mr. W. Bradley Miss E. Challacombe Baker Street Miss L. Duckett Broadway Mr. A. Pearce Acton Meritoriolls First Aid Certificate Mr. E. Holden Chelsham Team Plaques Challenge Shield 1954 Broadway (women) Hally Tablet Competition Mrs. E. McMillan Neasden 1st 1st year medal W. Stevenson Clapham 2nd 1st year certificate A. Sheen Romford 3rd 1st year certificate Miss A. M. Burnell Broadway 1st 2nd year medal J. Edwards Clapham 2nd 2nd year certificate E. Upfold Lots Road 3rd 2nd year certificate Charlton 1st E. J. Talbott 3rd year medal F. Mulholland Dorking 2nd 3rd year certificate J. Munn Epping 3rd 3 rd year certificate

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

News and Notes Continued Furtherance of First Aid Certificate Mr. T. Clift Vauxhall Reigate Mr. W. Kirshner Miss F. M. Hutchings Chiswick Webb Trophy First Aid Competition 1954 The Annual First Aid Competition for the Webb Trophy took place at the Ambulance Hall, Baker Street Station, London. This is an individual competition for women members of the Centre and consists of a practical and oral test. The practical test was an accident in the home where a man severely cut his arm whilst repairing shoes. He was also suffering from shock. Competitors were required to render efficient First Aid within the seven minutes allowed for the test. First year (Certificate) and 2nd year (Voucher) members were granted 8 % and 5 % additional marks respectively. The winner was Miss M. Burrell of the Staff Adminstration Office, Broadway who obtained 133 marks out of a possible 150, being followed by Mrs. E. Barrett of the Operating Department (C.B. & C.) Reigate Mrs. E. McMillan of with 106 marks. Neasden Railway Depot was third with 93t marks and Miss E. V. Green of the Accounts Office Broadway was fourth with 92 marks. The individual Test was judged by C. F. Blake, District Secretary No. 2 (North··West) District and Corps Staff Officer, London Transport Corps S.J.A.B. whilst Mr. E. N. Hawkins District Secretary No. 10 (Southern) District officiated at the Oral Test. Royal Sanitary Institute's Health Congress Approximately 2,500 delegates from all parts of the world are expected to attend the annual Health Congress of the Royal Sanitary Institute, 90 Buckingham Palace Road, London, S.W.!', which will be held at Bournemouth from April 26th-29th, 1955. The Duke of Wellington, K.G., Lord Lieutenant of Hampshire, as President of the Congress will deliver the inaugural address. Medication of Babies Boric (or Boracic) Acid and Borax The Ministry has had inquiries about the use of Boric (Boracic) Acid, and of Borax for babies, following cases recently when their misapplication through ignorance has proved fatal. One case was last September when an infant suffering from thrush was treated with glycerine and borax and the greater part of 2 ozs. of the preparation consumed in two or three days with ~atal results; (the only other fatal case of thIS nature reported was in 1928 when an infant suffering from the same condition was treated with honey and borax.) The second case was last November when a child of three months died in hospital after its sore and raw buttocks had been tre?ted for a week with pure Boric (Boracic) ACId powder, the absorption of Boric Acid being assumed to have caused the death. The following points are given by the Ministry as guidance. First, as a general principle, the Ministry recommends that it is best for parents to get guidance from the doctor or health

visitor before glvmg any medicines or medical treatments to babies. The quantities prescribed for babies and toddlers are usually very small and even a slightly larger dose, or too frequent or too concentrated appl ication can prove harmfu lor dangerous. Secondly, with regard to Boric (Boracic) Acid, mothers are warned :1. Not to use undiluted Boric (Boracic) Acid powder (except on medical advice) ; 2. That there are particular dangers in its use when the skin is sore or broken. (Dusting or talcum powders for babies usually contain only 5 % to 10 % of Boric Acid.) Thirdly, regarding glycerine and borax (or honey and borax), if this is prescribed for thrush it should be applied sparingly and only over a limited period of time; for instance, a baby should never be given a dummy which has been dipped in it. The Fourth Commonwealth Health and Tuberculosis Conference This will be held from 21st-25th June, 1955, at the Royal Festival Hali, London. It is open to all interested in preventive medicine, including the medical and veterinary professions, commercial and industrial e~ec:utives, nurses, social workers, health admmistrators, members of public authorities, regional hospital boards, etc. Futher details are obtainable from the N.A.P.T., Tavistock House North, London W.c'l.

Trailing The Common Cold With the completion of its eighth year of activity the Common Cold Research Unit is again appealing for volunteers to enable it to pursue its studies during 1955. Anyone wishing to volunteer should be between 18 and 45 years of age and in normal health. A line to the Medical Officer, Harvard Hospital, Salisbury will • bring full details. New Strain of Virus During 1954 members of the unit have been working with a new strain of common cc;>ld virl;ls, which has properties thought to dIffer slightly froJu strains studied in the past. The new strain, when diluted and a~mini.stered in. the form of nasal drops gIves nse to a hIgh proportion of colds in volunteers. The incubation period appears to be rather longer than that previously observed at this unit and although there is abundant running fro~ the nose, there is very little general feeling of illness and the symptoms are shortliv~d. The lines of research at present belllg followed include studies of the variations in the clinical effects of different common cold virus strains and their e~amination in the laboratory for possible tlssue culture changes. Health Visitor and Family Development An award of fifty guineas is to be made b~ t~e Royal Sanitary Institute for a prize wmnmg essay on ' How the health visitor can help the family towards its full development.' Full details can be obtained from the Secretary, Royal Sanitary Institute 90 Buckingham Palace Road, London, S:W.l: , Lung Atlas ' in English ~n anatomical atlas of the human lung, WhICh has already achieved world-wide

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

success, is to be published in 1955 in English and French by the Hungarian Academy of Sciences. The book, by Ferenc Kovats and Zoltan Zsebok, is stated to be the first successful attempt to lay open the X-ray anatomy of the chest with lung stratum photographs. The photographs are accompanied by unique drawings by Kovats giving a 'three-dimensional' anatomical picture of the lungs and chest. New TB Spinal Operation A new operation for tuberculosis of the spine, described as unique in medical science, is reported in the Hungarian newspaper Magyar Nemzet. In serious cases of tuberculosis of the spinal bone the patient becomes hunchbacked and paralysis may set in. Treatment in the past has usually involved lying on a plaster bed for three years and wearing a corset afterwards. The new treatment enables a patient to walk three months after the operation and to return to work in six months, the paper claims. Seven of the new operations have so far been carried out at the Debrecen Tuberculosis Institute by Dr Jozsef Schnitzler, chief surgeon there. Two or three rib sections are cut away near the affected part of the vertebra. The vertebra is bored out and the diseased part scraped away. The hole is then filled with a product made of the patient's ground bone, mixed with streptomycin and penicillin. The vertebra is then strengthened so as to prevent its collapse and the patient To do this, becoming hunchbacked. healthy vertebrae above and below the affected one are chiselled out and bone laths, made from part of the patient's hip bone, are grafted in. Operations of this kind began last summer. Of the seven patients so far treated two have left the Institute and three are already walking about. N APT Health Lecturer for Scotland The Scottish Branch of the National Association for the Prevention of Tuberculosis has appointed a Health Lecturer for Scotland, who will visit organisations in all parts of the country, lecturing on health, nutrition and the prevention of tuberculosis. She will show 16 mm. ' sound' films, by a portable cinema projector which can work in any place where electric current is available. The Lecturer is Miss J. M. E. McVicker, RGN, SCM, HV Cert. Miss McVicker trained as a nurse at the Royal Infirmary, Aberdeen, and studied for the Health Visitor Certificate at the University of Edinburgh. She has worked for the Midlothian and Peebleshire County Councils, as a health visitor on general duties, and also as a tuberculosis health visitor. British Transport Commission Heaton Mersey Ambulance Competition. The above competition was held recently and six teams entered. The team test was realisticly staged, and consisted of a The teams were village sports field. required to deal with an injury to one of the players in a football match. The competition was judged by Dr. K. D. Bean, and M. Maxwell Reekie, assisted by Messrs. Lunt and Ash. At the subsequent presentation, J. A. Knapman occupied. the chair,

-- ---- - -

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W hen you receIve a wound or

activities-and thus themselves slow down the process of healing.

burn, your body mobilizes its

(Furacin' , however, is an entirely new type

repair squad to make good the damage. Infection by bacteria hinders the repair squad III its

of germicide, which destroys bacteria and prevents

work and may even overwhelm it, so that the wound

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heals slowly or not at all. So infection must be pre-

squad unharmed to get on with healing the wound .

vented or suppressed, and this some of the older

For this reason, (Furacin' is becoming more and more

antiseptics do quite effectively.

widely used in hospitals and first-aid rooms in this

But no antiseptic, however efficient, will heal a wound;

c()untry and America.

only the repair squad can do that. The drawback of

Made up as an ointment, it IS easy to handle, and

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FIRST AID & NURSING, JANUARY/FEBRUARY 1955

* First-Aidel·~s Crossword No. 15

News and Notes (continued) supported by the Mayor and the Mayoress of Stockport, and the Chief Constable.. The competition was won by Longslght, and Salford were placed second. Heaton Mersey No. 1 and No.2, London Road Goods and Edgeley also competed.

Compiled by W. A. Potter

The above class held their Annual Presentation of Awards in the village hall at Rasland. G. Aston, District Operating Supt., Rotherham, presented the aw~ds and was supported by D. D. Scott, Dlstnct Motive Power Supt., Toton, T. Drackley, Yard Master Rasland who is the president of the class. ' Included in the presentations was a 41 years car for C. Barber who retires from the railway services in January 1955, and has completed 41 years service in the railway Ambulance Movement. British Railways, Western Region CARDIFF GENERAL concert and presentation of first aid awards was held in the Staff Canteen. R. P . Preece, Station Master, who is the President of the class, presided and presented the awards to 67 successful candidates. GLOUCESTER EASTGATE annual dinner and presentation of awards was held at the Midland & Royal Rotel, Gloucester. A. D. Cochran, District Operating Superintendent, L.M.R., occuried the Chair, supported by Messrs. A. H. Nicklin, F. Sparkes, L. M. Starr, G. Willmott, J. Ramsden and Mr. W. E. .. Perks, District Ambulance Secretary. The President thanked members of the class for their continued support, and also others who had contributed to the success of the class. He appealed for new recruits into the ambulance movement. Doctor J. Greene, the class surgeon instructor, presented the annual awards. On behalf of the officers and members of the class Mr. Cochran handed to R. Staite, the class Chairman, a wristlet watch upon the occasion of his recent retirement from the railway service. PLYMOUTH, NORTH ROAD AND DOCKS classes held their presentation of awards in the Staff Association Institute. F. G. D~an, District Traffic Superintendent, presided, and the presentation of awards was made by the Lord Mayor, Alderman E. W. Perry. RED RUTH presentation of awards was presided over by M. H. Kingdon, Station Master, F. G. Dean, District Traffic Superintendent, presented the awards and congratulated the class on its splendid record during the 28 years it had been in existence, and paid a particular tribute to the work of E. F. Bealey, who had been class secretary for 22 years. Mr. Dean made an appeal to young railwaymen particularly to join the first aid movement. Tribute to the co-operation which had always been forthcoming from the class was paid by ex-Superintendent C. V. Holland, representing the two St. John Ambulance Brigade Divisio ns in Redruth. WORCESTER AND DISTRICT presentation of awards was presided over by J. H. F. Page, District Operating Superintendent. Among the guests were the Mayor, Councillor Mrs. F. Rosa RatCliffe, H. R. Webb, Stores Superintendent, and Mrs. Webb, Mr. Page thanked the doctors for their help to the movement during the year.

ACROSS 1. Could this lesion be caused by 8. 9. 10. 13. 15. 16. 17. I 9. 20. 21. 23. 24. 25. 27. 31. 32. 33.

the teeth of an Artie gale (5,4) A black way of re-doing (7) She will certainly know her vitamin A, B, C's (9) Calm, nevertheless sick in the end (5) Manipulative "eduction- mostly 2nd cervical vertebra (5) Sudden sharp pains (5) Deliberate mischief from little mother with parasites (6) Large Stringed Instrument in short (5) Disease prevented by fresh fruit and vegetables (6) Treatment of shock and provision of Medical Aid are Examples from first-aid (6) Partially digested rood as it leaves the stomach (5) Cry-with a running nose (6) Villa in Birmingham (5) Nurse Cavell-To her friends (5) Reformed Taste (5) Paid to the lecturer (9) He may try to ascertain the cause of death (7) Physical sign which may indicate lowered bloodpressure (4,5)

DOWN 1. 2. 3.

Become pale and slowly die Descriptive term for compound fracture Cqncealed hint-not a broad one ...

4. 5. 6. 7. 11. 12. 14. 17. 18. 22. 26. 28. 29. 30.

Copy Listlessness Condition of bone which results in many fractures A solid tonic will do for this joint injury Small-pox Prophylactic change in condition which may be due to carelessness of first-aider Struck a hard blow Revolution on being removed from cyclone Produce Eggs ... Must tea changes-important Biologically ... Dinlinutive person, may h ave pituitary defect ... Cut from pins misplaced Medicine ball? Formerly

IAUNICIPALL Y SPEAKING (7) (5) (11) (11) (1l)

(11) (5)

(7) (5) (4) (4) (4)

SOLUTION TO CROSSWORD NO. 14 ACROSS 10, annul;

11, undulates; 12, dry cough; 13, coryza; 15, Eros; 16, whoop; 17, beds; 20, mind; 21, plate; 22, here; 25, litter; 27, elephant; 29, Germicide; 30, alien; 31, rough handling.

DOWN (4) (4)

(4)

Bedfords a, • ever, a,t In

(5) (3)

(Solution next issue)

1, A happy new year;

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DODODODODR.D.[J. O.O.O.O.DOOOODO DOOOOOOOO••O.O. O.O.O.O.O.EJOOOO .~EJ.EJOOOEJ.O.O. EJOOOO.O••EJOOOOO .O.O.EJOEJOO.O.O. EJOOOOO.O.EJOOOOO .O.O.EJDOEJO.O.O. EJOOOOO••O.EJOOOO .oao.EJEiJOOO.O.O. EJOOOO.CJ.O.EJ.EJ.EJ .O.O••[][]J000000CJ EJOOOOOO.O.O.O.O .O.O••ruOOODODDO

Has/and Ambulance Class.

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

2, Honeymoon; 3, pillow; 4, young child; 5, ends; 6, yellow; 7, aptly; 8, day-dream; 9, Asia; 14, portal vein; 18, elevation; 19, sweating; 23, vexing; 24, sprawl; 25, legs; 26, torso; 28, fish.

Day in, day out Bedfords brilliantly perform all the varied ..transport No tasks of public authontles. other range of vehicles has such a high reputation for reliabillty and economy. Modernly designed Bedfords form the ideal 'one-make' fleet; they pay in every way! 'Onen1ake' transport means greatly simplified maintenance and spare part stocking. To this add the extra Bedford advantages of low first cost,

low upkeep cost, low-priced readily available replacements, and Square Deal Service from 470 authorised Bedford dealers. With a range of chassis covering all loads from 10 cwt. to 10 tons, there 1s a Bedford for every local government needyou see them everywhere. Full particulars from your local Be?~ord dealer, or writedirectto the MUl1lClpai Vehicle Department, Vauxhall Motors Limited, Luton, Beds.

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i .~

~"C

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FIRST AID & NURSING, JANUARY/FEBRUARY 1955

Answer

Beaders~

queries Answered by Dr. A. D. Belilios

R. 1. S. (Hereford) writes :Why is it that we are not alloll'ed to prick blisters in Burns and Scalds-it is easy to do and quite painless to the patient ?f done properly ? Answer

There are several reasons for this rule. Firstly, burns and scalds are fundamentally sterile (i.e. free from living germs,) and unless a blister is pricked under full aseptic precautions (almost impossible to attain in first aid) germs are likely to be introduced and sepsis set up. Secondly, a blister may in itself be protective, forming as it were, a water cushion over a raw area which would be very painful if exposed to the air.

F. W. R. (Winchester) writes The S.J.A.A. Manual refers to poisoning sometimes being caused by injection with a hypodermic syringe. In what circumstances can this occur please? Answer Many drugs given by injection are poisonous if the normal dose is exceeded e.g. Morphine, Atropine and Insulin. The circumstances are usually accidental-a diabetic may use by mistake a double or triple strength solution of insulin. Suicidal and homicidal cases also occur. See if any of your friends can lend you a detective story called 'The Missing Money Lender'.

A. J. M. (Cardiff) writes :_ Recently I heard of a child who had to be removed to hospital on account of prolonged bleeding /rom a small wound of her hand. 1 was told that this had happened to her before and that there was even danger to life. Would you please give me some in/ormation on this unusual case together with the recommended first aid treatment.

The child is almost certainly a sufferer from the hereditary disease called Haemophilia, a complaint which almost always affects males although it is passed down through females. It is due to a deficiency in the clotting power of the blood and prolonged bleeding can o~cur from many sources e.g. the nose and gums. First aid comprises direct pressure on the wound over a gauze or lint pad and also the general principles for the treatment of haemorrhage. Medical measures include transfusion and local applications which promote the clotting of blood.

* F. W. S. (Colchester) writes : May I ask through your valuable Journal, )vhat is the correct first aid fo adopt for these amateur carpenters who, when knocking in a nail, miss their aim and hit their own finger nail instead. It is an unpleasant accident as 1 havefound to my cost. Answer The accident is one for which medical advice should be obtained. There may be a fracture of the phalanx which can only be diagnosed by an X-Ray. The blood under the nail, which causes the black appearance, may be released by a doctor who may make small trephine holes through the nail near 'the quick'. First aid, therefore, is on general principles. If a wound is present, dress with a dry dressing or with tulle gras. Apply a small splint to the palmar aspect of the finger and bandage in po~ition. Advise the patient to support his hand in a slightl.\' elevated position e.g. over one of the upper buttons of his coat, or use a sling.

A. 1. S. (Tonbridge) writes As a medical orderly, 1 remember the time when penicillin had to be given by injection f'pery three hours or so and the injections were painful too. With improvements, twice or even once daily injections became possible. Now 1 am getting out of touch but 1 hear that injections are being given up and the drug is given by the mouth. For general interest, I should be grateful for further information please. Answer

I am afraid your information is incorrect since injections remain the most reliable method of administraPreparations of the drug, tion.

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

however, are available for oral use and are increasing in popularity particularly for children up to the age of 12 months. Further research would appear to be necessary before it can be said that pencillin by the mouth is as efficacious as the injection method but time will tell.

"::.

:>j:t

Rapid Relief

K. B. N. (Worcester) writes :Several of us have been haVing a discussion on what is the best first aid fo apply in the case of a patient who has broken his left patella and also his right fibula just above the level of the ankle joint. As we cannot reach agreement, Jve should be ver), grateful zf you lVould submit the problem to Dr. B elilios for a verdict. Answer I don't know about giving 'a verdict' because there are always alternative methods of dealing with these combined injuries depending on their severity and, of course, on personal opinion. My view would be to regard the patella as the priority injury and to treat it according to the S.l.A.A. manual save for raising the right limb and securing it to its fellow by ,a figure-of-eight. A fractured fibula just above the ankle is not usually a severe accident and the tibia acts as a splint for the broken bone. It is sufficient, therefore, in most cases, to surround the ankle with cotton wool and secure in position with a firm roller bandage.

!\LGIPA J Balm is notable not only for ti.:; ra pid relief it provides in ~brositis and other

', '~~

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series of competition papers based on O UR40thnewEdition S.J.A.B. book now ready. Team

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( :c-a t: liness a !1d e:'.se of its application.

V ,

Miscellaneous Advertisements First Aid & Nursing, 32 Finsbury Square, Lond:>n, E.C.2. Rate 4d. per word, min imum 65. Box

rl-e uE:' 8. tic c o :~ d itions, but for the simplicity,

"":J)}

OF THE

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CARDS, 250 17/6, 1,000 52/6. Tickets, SCENT Posters, Memos. Samples free- TICES, 11 Oaklands Grove, London, W12.

... akina of Nurses' Uniforms for nearly 100 years and have We have sP:~~~~~ti~~ %er ~ood quality materials and superb workmansh~p.

Car Badges, 30s. S.J.A.B. Badge Wall S • I.A,B. Sb.ields, 26s. 6d. S.I ,A.B. Gold cased crested

knowmg that every You can ord er your St . John Ambulance Uniform with 'th confidence, l' detail will be in accordance WI regu arlOns.

Cuff Links, 42s. S,J.A.B. Badge Ladies' Broocbes, 15s. Trophy Shields supplied. White' Old England ~ shins, 21s. 6d.; Poplin quality, 30s. (state collar size). Medal ribbons 9d. each on buckram for sewing on uniforms, Is. each ribbon if mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for leaflets.-Montague Jeffery, Outfitter, St. Giles Street, Northampton.

We shall be pleased to send full details upon request.

ill==::============== E. & R. GARROULD L TD. ==========~=====~! 1 5 0 - 1 62

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FIRST A1D & NURSING, JANUARY/FEBRUARY 1955

UNIFORMS and LADIES~ GREAT COATS & COSTUMES MEN~S

for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

HOBSON & SONS (London)

FIRST AID & NURSING, JANUARY/FEBRUARY 1955

·c~ ·

"PORTLAND" AMBULANCE GEAR

The Gear illustrated(A.B.C.D.} carries two stretchers on one side of Amb ul ance, leaving other side clear fo r Sitting patients. The UP AND DOWN action is qu ick and easy for loadi ng or unloading. A . Shows the two stretchers in position. B. Shows the top stretcher lowered ready for loading.

C. Illustrates the same Gear With the top stretcher frame hinged dcwn for use when only one stretcher case is carried. D. Sb<Jw5 the same position as in "c' only with cushions and back rest fitted for convalescent cases.

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FIRST

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TO THE INJURED AND SICK Edited by A. P. GORHAM, M.B ., Ch.B., M.R.C.S.

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'FIRST AID J WALL DIAGRAMS 26 X 40 in.

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A HANDBOOK OF

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In this Issue Cadet Saves Life

To Our Correspondents

Publications Received Sussex County Finals ...

Police National Competition Finals From a Seat in the Audience

Institute of Certified Ambulance Personnel

Apoplexy and Epilepsy

Notes on Advanced Physiology

Pulmonary Tuberculosis

First-aider's crossword

News and Notes

Readers' Queries

no you know that • •• 1 The virus of chicken-pox is identical with the virus which causes shingles ? 2. St. Paul was respo?nsible for the introduction of nurses' caps . 3 The correct method of lifting a kettle is by passing the hand under, not over, the handle? 4. Asphyxia, following el~ctric shock, is due to paral~'sis of the respuatory centre in the brain ? 5. Plenty of fluid (at least three pints per day), by s~fte~ing? the faeces, helps to prevent constipation . 6. Dogs are immune to anthrax, fowls are immune to tetanus ?

Cadet Saves Life Is it worth while training cadets ? Let the following story, related to us by Staff Officer L. Wills of the Eastern Area London District, S.J.A.B., answ~r this question, which we frequently hear asked. On Shrove Tuesday the parents of Martin Donald Attenborrow, a St. lohn Cadet of Manor Road , Laindon, Essex,' invited their ne~ghbours to a television session whlch they accepted, bringing their infant S?ll, aged 16 months, with them: Dunng the evening the child was mIssed and it was assumed that he had wandered out of the house whilst the attention of the parents had been concentrated on the screen. A search began, and, after some time, the child w~s discovered in the pond a short dlstance away. Upon being dragged out he

was found to be uncon cious, aud breathing had ceased. Without a moment's hesitation Cadet Martin, who is only 12 years of age, was on his knees performing artificial respiration, and thi he continued until the arrival of Dr. Chowdhary. Noting the cadet's accuracy, the doctor told him to carryon, and shortly afterwards, to the relief of all. breathing was restored. Dr. Chowdhary stated that, without a doubt, the child' life had been saved by the promptitude. knowledge and skill of Ca~et 1artin Attenborrow. He has wce been presented with a medal by ~r. Yeoman, vice-president of the Lall1don Ambulance Cadet Division. S.l.A.B., of which Martin is a member. Is it worth while training cadets '?

To O.,r Corrcspondellts Because owing to lack of space, we are unable to introduce a correspondence column it must :not be assumed that we do not apprecIate the many letters we are continu~lly receiving from our readers. W~lst unable to pub1i~ h them we do lIke to hear from you, and to learn your views, even if, on occasio?,. we may not agree with the 0pullons expressed, as in the case of one reader

recently who commented upon our article on 'Artificial Respiration.' Moreover, it will be appreciated that, as this journal caters for firstaiders and home nurses and. not medical students or professlOnal nurses it would be unwise to encou~age the development of scientific discussion suitable only for a medical periodical.

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2 FIRST AID & NURSING, MARCH/APRIL 1955

THE ST.

JOHN AMBULANCE

BRIGADE

.POLICE NATIONAL COMPETITION FINALS of the highlights of the competition ONEworld for 1955 will, undoubtedly, be

SUSSEX COUNTY FINALS THE County of S~ssex has always occupIed a promment position in first aId and horne nursing competitions, and on Saturday, 12th March, at LittIehampton, enthusiastic audiences watched the keenly contested struggles by ten first aid and six nursing teams for the seven magnificent trophies displayed in the great hall of the elegant ,new County Schools in Elm Groye. In both the first aid and nursing sectIOns there were four separate tests viz. a team test, an individual practical te~t fo; the officer in charge of the team. a dual practical t.est (first aid), a dual bed-making test (nursIng) and an individual practical test for No.4 of each team. The judges in the first aid section were Dr. H. Rosenberg of Worthing (team test), Dr. G. C. Gunder~ sen, of Brighton (officer individual), Dr. Ayres, of ~ognor (dual practical), Dr. A. SIess.. of Bnghton (No.4 individual). In the nursmg section the judges were Dr. C. R. Oyler, of Worthing (team test), Miss Stoneh~m, S.R.N., of Eastbourne (officer indiVldual), Miss Gillanders, S.R .N., of Henfield and Mis~ Smith, S.R.N., of Southwick (bed- ma k0g), and Miss Brown, S.R.N., of SouthWIck (No.4 individual). ~he men's team test represented an aCCIdent which is, alas, far too common. A motor-cyclis~, travelling at speed, strikes the ~e~b and IS thrown against the wall, sustammg fracture of spine, compound f~acture of left leg, lacerated wound of nght hand, fracture of right side of jaw and s~ock .. The patient is lying huddled on his nght SIde. The first aid team captain had to treat a man who had been knocked down by a lorry a1'!d ,:¥as suffering from a fractured pelvis, with mternal haemorrhage. Ambulance bearers Nos. 2 and 3 find a boy who has fa!len from a tree, with a ~ro~en bough lyrng across him. Blood is ISSUIng freely . from. right nostril, and a transver~e cut IS seen m the fleshy part of the nose wIth slight haemorrhage. Middle p~alanges of two fingers are fractured (SImple) and there is mild shock. No. ~ (first aid) sees a cyclist fall heavily on t? his left .shoulder, sustaining a fracture of nght clavIcle, graze on right knee and shock. The t~sts fo~ the nursing teams were equally rnterestmg, the team test being s?mewha~ complicated, but, at the same t!me, typI~~1 of what might Occur at any tIme. WaItmg for a 'bus the team sees an elderly lady approaching but before she reac~es the 'bus stop she f~lls. In her handbag lS found a broken gin bottle, a diabetic card . and some glucose sweets. She is suff~r.Ing from an overdose of insulin but in addItIOn, sh.e has ~ deep cut in the palm' of !eft hand wIth an Immovable piece of glass Imbedded, and a Colles fracture of left wnst: A c~rbuncJe on the neck beneath a dreSSIng IS Intended to mislead.

F~r t~e. t~am officer there was a case of of both eyes requiring bathmg, the left one to be dressed. Tn. the b.ed-making test for Nos. 2 and 3 cons~deratlOn had to be given to the fact that It was a heart case, and the bottom sheet had to be changed. conJ~nctIVltls

1\ ' daily. routine' test awaited No.4, the patIent belTIg bedridden following a fall and having a septic elbow. ' At the presentation ceremony the Chair w~s taken by Mr. W. Aylmore, Chairman of Llttlehampton Urban District Council who also presented the trophies, and h~ was s~pported by the County Commissioner LI~Ut.-COl. K. B. Hicks, O.B.E., O.SU.: MIS. Courtney, S.R.N., County Superintendent (nursing), Mrs. Royle, S.R.N., County Nursmg Officer, and the judges. .Opening the proceedings the Comn:lssJOner ~elcomed. Mr. Aylmore, thanking hIm and his CouncJI for the great interest they had s~own . He wi ~hed, also, to thank the Educatton Authority for placing at their servIce that day the magnificent new County Sc~ools, and also the domestic sClen.ce pupIls for the lovely tea they had prOVIded. Mrs. R~yle then proposed a vote of thanks to .the Judge, emphasizing the grea~ debt which the Bligade owed to the medical and nursing professions. The comments of the ju.dges are always welco~ed for the.v.aluable hInts they contain, and thIS competItIOn proved no exception. Dr. Rosenberg led the .way, and explained that he h~d been roped In at the last minute t.o deputlse f~)f Dr. Wi iliams. Discussing the figure-of-eIght bandage for tying the feet to.gether, he said that, although he agreed WIth those who tied the knot on the side of the sole, the text-book stated that it sh(~)Uld be tied in the centre, and they must abIde by the book. Moreover, it must be a reef knot? not a bow, a habit sometimes contracted In the practice room for speed in unt.ying. He did not like to hear competItors . arguing with the judge. 'We set a very hIgh standard in Sussex' he said and he hoped that his criticisms would be accepted as they were intended, to help. Dr. Oyler followed, saying that he thought the nurses were more composed than the men, a fact which gave them a marked advantag~. He could not refrain from commentl~g . upon the nurse who had wre~ched WIth great strength' his' beautiful . ~ovable piece of glass' from the patI~nt shand! He congratulated the nurSll1g teams upon the manner in which they had tackled the task. . . Miss Stonch~m spoke for all the lady Judges, and saId that they would like to thank the. large audience for their most sympathetIC Support. Referring to one or two of the tests, she said that the nurses had been, extref!1ely good, but 'Do first things first (quotIng from the B.R.C.S. text-book).

FIRST AID & NURSING, MARCH /APRIL 1955

Wit~ regard to the bed-making, it was ObVIOUS that more practice was required and both nurses ,must work together. Again' the~ must take mto consideration what th~ patIent IS suffering from. In this case it was heart. trouble, requiring absolute rest and a mlTIlmum of movement. In bathing the eyes, swab from the inside out, and use a swab only once. The announcement of the results followed together with the number of marks gained by each team (marks possible: 400) :_ 1.

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

First Aid Brighton Police (winning the Sir Wil1ia~~' Genti~ CuP. and also the Dorothy J~rvls Cup for highest indiVIdual score) Southwick' A ' (winning the Frederick' Cadb'y Cup) Eastbourne Worthing' A' Hove and District Railway H~sti,?gs (Milton) ... . .. (wmnmg the St. John Council Cup) Southwick' B ' Crawley ... Brighton Town Worthing

372

345t 339

315i 305 293t 275 264 242

238i

Nursing Worthing 254t (winni ng the Sir'Willia~ Genti~ Cup) 2. Brighton 227 3. Horsham 225 4. Southwick (winning the St."John"Coun~·ii 218t Cup) 5. Lancing .. . 208i (winning the Offord Cup for bed-making) 6. Eastbourne 200t

Mr. Aylmore was then invited to present the trophies. He said that he was pleased that Llttleham~ton h~d been chosen for the County FInals. Whenever you wish to stage an ev~nt of any kind,' he said, ' Littlehampton will always be pleased to welcome you.. He referred to the' terrific training' reqUIred to pe~fect ambulance men and wome.n for servIce to the community and m.anklOd. He congratulated not only the wmners but also the runners-up, for, he said, there must always be runners-up. ' The proceedings terminated with a vote of thanks by Mrs. Courtney to the stewards patIents and especially to Miss Allen th~ headmistress .of the school, wqo had cooperated so wIllIngly.

the introduction of the mixed team, an experiment by the Metropolitan Police. The team concerned was that of L Division, No. 9 District, and the success of the experiment may be judged by the fact that this team, which included W.P.c. Miss Edna Chapman, the only woman competitor in a 'field' of 55, was the proud runner-up for the Pim Trophy. This Competition was held on 25th February last at the Porchester Halls under the auspices of the St. John Ambulance Association, and attracted a large audience. It consisted of two parts, a team test and dual practical tests. The team test was unique in that it presented a touch of real drama. The team is watching a dress rehearsal of a dramatic sketch for a concert, at which they are afterwards to give an exhibition of first aid. After a piece of very fine acting by the heroine (Miss S. Marsh) she takes a gun from a drawer and shoots the villain who is approaching her. The producer is satisfied, but, after a pause, during which the victim has failed to rise, it is realized that something is wrong. It is then discovered that, by some terrible mistake, live ammunition had been used, and a serious accident has occurred, when the producer appeals to the team for assistance. Examination shows that he has a penetrating wound of the chest wall, slight external haemorrhage and a simple fracture involving the left elbow. The test was set and judged by Dr. V. C. J. Harris, of St. Bees. In the dual practical test, Nos. 1 and 2 find a man who has fallen from a first-floor window, and has a severe wound of right forearm, with glass embedded, a Potts fracture of right leg and shock. Nos. 3 and 4 find a man lying in a pool of blood, having apparently, been stabbed. It is found that he has sustained a punctured wound of the abdomen, fracture of both sides of jaw and shock. Dr. J. Kensal! Thomas, of Dunstable, was responsible for the setting and judging of the dual practical tests. Eleven teams had entered for the competitions altogether. The presentation ceremony was presided over by Mr. Horace Parshall, T.D., M.A.(Oxon.), Director-General of the st. John Ambulance Association, and he was supported by the Rt. Hon. Gwilym L1oydGeorge, M.P., Secretary of State for Home Affairs, Lt.-General Sir Henry Pownall, Chancellor of the Order of St. John of Jerusalem, and the judges. In welcoming the Home Secretary and Sir Frank Newsam, from the Home Office and Miss E. C. Bather (Metropolitan Police), he said that to those engaged in promoting the study of first aid it was most encouraging to note the interest taken by these important people. He also wished to extend his welcome to Sir Henry Pownall, for, however b';1sy Sir Henry might be he always finds tlme to attend these functions. Mr. Parshall then extended the sincere thanks of all to the Associated British Picture Corporation Ltd. for their co.ntinued generosity in supplying and erectIng the stage settings-especially the gun! He hoped the bullet had now been extracted and that the weapon had by then been rendered

harmless! He also wished the victim a complete recovery! Tribute was then paid to the work of the judges. 'Doctors are busy men,' said Mr. Parshall, ' but they are always ready to give their time and skill to the promotion of the teaching of first aid, and it was from them that the students learned so much.' There were many others he would like to thank, but it was impossible to thank them all. He trusted that they would all accept this expression of gratitude. Dr. Harris, in responding to the Chairman's invitation to comment upon the team test, commenced by saying that the previous night he was watching' The Crazy Gang,' but he would not for one moment think of making any comparison between their performance and the splendid piece of acting he had seen on the stage that day! He would, however, compare their performance with that of some teams who, like 'The Crazy Gang,' did everything wrong. Yes, he knew that he was being candid, but he hoped that they would appreciate his can dour. There were two great faults which he had noted. In the first place, the penetrating wound of the chest wall should have been treated before anything else. The other point was that the excitable and objectionable female should have been got out of the way and finally disposed of. 50 p.C. of the competitors omitted to apply a sling in the case of the fractured ribs. He hoped that they would bear these criticisms in mind and would not be too hard on him. However, he had thoroughly enjoyed every minute of the day, and thanked them for their indulgence. Dr. Thomas followed, and said that, like Dr. Harris, he had thoroughly enjoyed judging. However, he too had some criticisms to make. Although it was a cold, frosty day, only two teams got their patient to shelter within the scheduled time. Again, they continued to work in a bad light when there were obvious means of admitting more light. He had purposely introduced some catches, but he trusted that all the competitors appreciated and enjoyed tham. 'Don't do It again' he concluded, referring to the errors which had been pointed out. Then came the moment for which everyone had been anxiously waiting, when the results of the competitions were read by Col. E. Croft, Deputy Director-General of the St. John Ambulance Association.

3. 4. 5. 6. 7. 8. 9. 10. 1].

Results (Maximum m arks possible, 400) Birmingham City Police No. I ... (Winning the 'Pim' Challenge Trophy) Metropolitan Police (L Division) (including lady competitor) ... (Winning the 'Police Review' Challenge Cup) Exeter City Police Brighton Borough Police Royal Ulster Constabulary Cardiff City Police North Riding Constabulary 'A' Edinburgh City Police ... Cambridge City Police ... Wallasey County Borough Police Derbyshire Constabulary

Plaq.ues were received by the individual members of the winning teams, which had been presented by the St. John Ambulance Association. In accepting the invitation of the Chairman to present the Trophies, the Home Secretary said 'I am always glad of an opportunity of seeing at first hand the work of first-aiders, and I was very glad to see these teams at work this afternoon, especially as J have always had a special respect for the police force.' He extended a special welcome to the teams from Scotland and Northern Ireland who, he said, must have been particularly keen to travel all those distances in order to attend. The competition had been remarkable for skill, and he congratulated the judges who had devised the tests. He expressed his grateful appreciation to the Order of St. John, for he felt that they were under a great obligation to them for the part they had played in organising the training of students in first aid. 148 teams had entered the eliminating competitions, the highest number ever recorded , but he reminded his audience that first aid was a most valuable acquisition to all as well as to the police. 'My hearty congratulations to all the teams,'heconcluded, 'and especially to the winning team which will go forward to compete for the Grand Prior's Trophy.' The proceedings ended with the thanks of Mr. Parshall to the Home Secretary for his interest and for presenting the Trophies. He added that last year over 90,000 new certificates had been issued.

336

309 306 298 296 285 266 264 255 250 235

W.P.c. Miss Edna Chapman (left), of L Division, Metropolitan Police, runner.s:up in the Police National First Aid CompetItion Finals, and winners of the 'Police Re~~w ' Cup, was the only lady in the Competition. She has been in the Force three years and, althouah she was married on 26th March, intend; to make the police her career. It is regretted that the Report of the British Electricity Ambulance Centre has owing to restrictions on space, to be held over to the next issue (May, June).

FIRST AID & NURSING, MARCH/APRJL 1955

From a seat in the audience Some random (and provocative) comments on the competitions Police National If stretcher drill has been well learned it should not be necessary to give so many detailed instructions. The revival of the 'nuisance' is noted with approval. The recitation of a list of possible symptoms does not constitute diagnosis. Only three competitors thought to empty the remaining barrels. The acting of the 'heroine' (Miss S. Marsh) deserves special mention. Too much attention was paid to the , heroine ' when a patient needed treatment. Make certain that there are no obstacles in the way before placing stretcher. One competitor apologised to the , producer ' for having left the place in such a mess. This is realism if you like. It is not necessary to recite whole paragraphs from the text-book. The judge is not impressed, and, after all, he knows them. . To those competitors who recorded 'Ladbroke Grove' instead of 'Ladbroke Crescent '-where was your observation? Not all remembered to remove the pa tient's dentures. Surely it was a miracle to see hot-water bottles produced from an empty house ! Could they really see to examine eyes, face, etc., in that dark corner? Again we saw glass bottles used as hotwater bottle~. Trivial injuries were often treated before major ones. 'Discriminating' is the sixth of the eight-pointed star. Blanketing stretcher is improving. It should be carried out as a drill.

More care should be exercised in loading ambulance. 'Expose the wound.' You can neither diagnose nor treat otherwise. , Sympathetic' is the eighth of the eightpointed star. You are treating a human being, not a block of wood. Whence did he expect ice? It was an empty house. Best wishes to Miss Chapman on her wedding, from ' A Seat in the Audience.' Rubbing up AND down is not promoting circulation! Who was the competitor who, when testing stretcher, thought he was there for the night? 'Thank you for your help'-realism again. Three competitors fanning the patient at once! ' Blankets on top are useless if sides are uncovered. One policeman removed his helmet-and those of all his colleagues. Only one asked the' nature of the ground to be traversed.' Don't maul the patient. Make certain you know what you are looking for. Sussex County Finals Was it not useless to try to question the patient in that condition ? There was no systematic diagnosis. That barrel bandage must be practised in awkward positions. Now, nurses, lift .that kettle correctlysee ' Do You Know That.'

That nail-brush was not put there as an ornament. There was too much unnecessary 'phoning. 'Why did she fall?' This question would have led to diabetic clues. Why lift patient to seat if comfortable on the ground ? It was dry. Bed-making requires more practice. Movements of the two nurses did not always synchronise. Treat it as a drill. What about the windows before commencing bed-making or treatment? Oh! Those bed-clothes on the floor! Uncertainty and hesitancy upon learning that it was a heart case. Too much' unnecessary discussion about trifling matters '- see page 13 of text-book. Don't explain how you would fill a hotwater bottle. Do it. Foments should be wrung more tightly. I am afraid there were some scalds. We would like to see less prompting by the judges. Did they think they could carry the patient for 10 minutes on a hand seat? The diagnostic value of . history' is often overlooked. It is useless to ask a semi-conscious patient if he has passed water. Find out. Internal haemorrhage-' Give nothing by the mouth' (page 108 of text-book). Avoid movement until a diagnosis, more or less complete, has been made. Ps),chology. was of a very high standard, both 10 first aId and nursing.

Institute of Certified Ambulance Personnel SPEAKING at the Annual General Meeting of the Institute of Certified Ambulance Personnel, held at St. Mary's Hospital, Manchester, on Saturday, 5th March, 1955, Mr. T. Pearson, the County Ambulance Organizer for the Lancashire County Council, paid tribute to the good work the Institute is doing in raising tbe status and efficiency of ambulance personnel and industrial first aid attendants. Speaking personally, said Mr. Pearson, 1 have a great deal of sympathy with the aims of the Institute, and I should like to see full recognition given to its Diploma. T he greatest possible credit was due to the Institute for its work in raising the standard of efficiency among ambulance and first aid personnel, and consequently in raising the status of tbe workers in this field. Lancashire County Council had already made a start in recognizing the Institute by paying the examination fees and encouraging personnel to take the Institute examinations. In doing this Lancashire County Council was performing a service for the ambulance world as a whole. Lancashire was an immense County, and t~ose who came from the South probably did not always recognize its extent nor appreciate the difficulties under which the

ambulance service was operating. This may also be true of the Ministry of Health. In the administrative County of Lancashire million. Add to there were nearly this the County Boroughs, and in the geographical County of Lancashire there were nearly Sf- million people. The ambulance service had to operate in an area which was 110 miles from north to south , and 20/50 miles from west to east. This presented a tremendous transport problem, but Lancashire took a great pride in the ~ervice they provided, and credit is due to all those who work in the ambulance service. The Ministry of Health were anxious to reduce costs, but the l.ancashire County Council were determined that nothing should be done to reduce efficiency. The needs of the patient were paramount, and first and last were the main consideration of the service. If costs must be reduced, ways and means would have to be found which did not reduce efficiency.

Radio Control Radio control might give some hope here, and the Council had already made this introduction. Personnel need not fear that they would become redundant with the introduction of radio control. An under-

taking could be given that no-one would be sacked when it was introduced. It was thought that the annual wastage would take care of the position . In conclusion, Mr. Pearson said, he had every hope that in the near future he could persuade the authorities in Lancashire to give full recognition to the Institute. Mr. Pearson then presented the William Fox Examination trophy to Mrs. I. M. Hulland, who had won it for gaining the top marks in the Institute examinations in 1954. Mrs. HulJand is employed in the first aid department of the Birmingham factory of Messrs. Docker Bros. Mrs. Hulland, who is a Fellow of the Institute of Certified Ambulance Personnel, will retain the silver cup (which was given by the Chairman of the Institute, Dr. W. W. Fox of Wimpole Street, London), until the next Annual General Meeting. In addition, . Mrs. Hulland received a small silver cup which she will keep as a permanent memento of her achievement.

New Examination Tn addition to discLlssing the report of the General Secretary, Mrs. N. E. Berger, O.B.E., the meeting . also discussed a

FTRST ATD & NURSTNG, MARCH/APRTL 1955 propo~itjon that the Jnstitute should organIze an examination which was of a standard lower than their present examinations, but higher than the examinations set by voluntary first aid organizations which were now accepted by Local Authorities. The Institute felt that by holding an examination of this kind, they would lay a stepping stone for those who felt that they could not at once embark on the present examinations of the Institute because of the high standard set. It is not the inten-

tion of the Institute in any way to lower the present standards of their Preliminary and Final examinations but the new examination would, it ~as hoped, .give encouragement to those who on their present standard of knowledge needed further training before they could become Fellows of the Institute. The new examination would not be compulsory, nor would it mean that those who had taken it could not if they so desired take also the Preliminary and Final

examinaLions of the Institute. The main , examination of the Institute continues to be the Preliminary and Final examinations which are in fact complementary and to b~ regarded '.ls. one examination. In asking for recogl1ltlOn from Local Authorities the Institute still continue to ask for recognition for the Fellowship diploma. Now that the Annual General Meeting has agreed by a majority vote that the new examination shall be organized, the Council WIll work out a new syllabus and full details.

COURSE IN ELEMENTARY FmST AID

Apoplexy and Epilepsy By A. D. Belilios M.B.) B.S. (Lond.), D.P.R. (Eng.) come in this T HEseriesstageof has articles on unconsciousness to describe some of the more common diseases which are accompanied by insensibility. These ailments have already been classified in a former issue of this Journal.

APOPLEXY This is a common cause of unconsciousness in people over the age of 50, although it occasionally occurs in those who are much younger. Apoplexy can be due to several causes. It may result from the rupture of a small blood vessel in the brain. The bloodvessel concerned has usually become weakened through the effects of high blood pressure over a period of years. Apoplexy due to a ruptured bloodvessel is known as cerebral haemorrhage in medical language to distinguish it from cerebral thrombosis which is caused by the formation of a clot of blood within a vessel. Cerebral thrombosis is not necessarily associated with high blood pressure; but there is usually hardening of the blood vessel and roughening of its inner lining which encourages the blood to clot. Cerebral embolism, another cause of apoplexy, results from the sudden blockage of a vessel by a particle of foreign matter carried in the blood stream. The particle may arise from several sources within the body, e.g., a diseased valve of the heart from which a fragment becomes detached. Apoplexy is commonly known as a 'stroke' or 'seizure' and the

actual causei.e., haemorrhage, thrombosis or embolism makes little difference to the first aid diagnosis or treatment. The onset, however, is variable, Sometimes, particularly when haemorrhage is the cause, the patient is taken suddenly ill on hurrying, for example, to work, particularly if his stomach is overloaded. He complains of a severe headache, feels faint and giddy and soon collapses. Other cases, particularly cerebral thrombosis, are more gradual in their onset and accompanied by headache and vomiting. Sometimes a patient is found unconscious in bed, the clot of blood having been formed while he was asleep. When unconsciousness is established, characteristic signs include a flushed face, unequal pupils which may fail to respond to light and turning of the eyes towards the affected side of the brain. The pulse is usually slow and strong while the breathing is accompanied by deep snores and spluttering of the cheeks with expiration. Sometimes Cheynestrokes breathing will be noticed. Incontinence of urine and convulsions occasionally occur. The unconscious stage may be of short or long duration and on recovery some loss of function of the body will generally be noticed according to the part of the brain affected. There may, for example, be paralysis of one side of the body, loss of the power of speech, memory, etc. The diagnosis of apoplexy is usually easy but the first-aider must

always be on the look out for cases of suicidal poisoning and, of course, the possibility of complications of head injuries. Drunkenness has often been confused with apoplexy but this should not occur. A smell of alcohol in the breath never in itself justifies a diagnosis of alcoh olism and if a patient is sufficiently drunk as to resemble one suffering from apoplexy, he should always be given the benefit of the doubt and treatment for the latter condition adopted. First Aid Complete rest is essential. Examination and handling of the patient should be minimal owing to the risk of increasing the bleeding. Whenever possible, removal should be deferred. Thus if the patient has a stroke in his dining room, he should be kept there and a bed made up around him. An attempt to carry him upstairs to his own room would be unwise. Naturally this advice cannot be followed on every occasion. The patient often has to be removed to hospital when he has a stroke on the street, or the racecourse, etc. The head and shoulders should -be supported on pillows in an elevated position which tends to reduce the bleeding in the brain. For the same reason, the trunk and limbs should be covered with blankets and a hot water bottle, well covered, applied to the feet. The head should be turned to the affected side, dentures removed aild the mouth kept clean by mopping

FIRST AiD & NURSING, MARCH/APRIL 1955

away froth, etc., with wisps of gauze or similar material. This cleanliness. is very important since if the patient inhales into his lungs infected material from his mouth, a variety of pneumonia called aspiration pneumonia-may follow. EPILEPSY This well known ailment occurs in two main types-major epilepsy (Grand mal) in which attacks of unconsciousness are accompanied by convulsions, and minor epilepsy (Petit mal) in which convulsions are absent. The first-aider is naturally more interested in the former variety since it requires active first-aid. The onset of the disease is usually in early adult life and thereafter fits occur at varying intervals. Sometimes for example, a patient will have a spell of fits over a short period of time followed by a long interval of complete freedom. Fortunately medical science has available several valuable remedies which will. prevent fits in the majority of subjects. Each fit can be described as passing through four stages as follows ;(a) The Aura (b) Rigidity (c) Convulsions (d) Recovery. (a) The aura is the name applied to the warning that many patients receive that a fit is imminent. Actually it is said that only about 50 % of patients experience an aura. The aura may take one of many fo~ms,. a feeling of unreality, the tWltchmg of muscles, blurring of vision, sound apparently heard or a word suddenly coming into the mind. Whatever the aura, the patient learns to associate it with the onset of a fit an~ this may give him the opportUDlty of getting himself into a position of safety before the fit begins. . (b) Immediately after the aura the patient sometimes utters a shrill cry and drops to the ground, becoming completely unconscious and often hurt~ng himself during the fall. He IS now in the stage of rigidity w.hich lasts for about 40 seconds. All hIS muscles are stiff, his joints cannot be bent, the jaws are firmly clenched

and his breathing temporarily ceases. His colour quickly changes to one of lividity. His appearance at this stage may be mo~t alarming. His eyes remain open and turned to one side ; the cornea becomes congested and red in appearance. (c) Forcible and involuntary muscular contractions, called convulsions now affect all muscles of the body. The patient appears to be violently twitching. The movements affect the muscles of the jaw and often the tongue and cheeks are bitten. The saliva in the mouth is, as it were, beaten up into a foam and bloodstained froth escapes from between the lips. Breathing begins again but is jerky and noisy; nevertheless it prevents death from asphyxia and causes the colour of the patient to alter to one of cyanosis (blueness.) Incontinence of urine and faeces is not uncommon. (d) Recovery is usually preceded by a short period of complete unconsciousness from which the patient gradually recovers but feels dazed ill and exhausted with a sever~ headache. If left to himself, he will often sleep soundly for hours. First Aid Obviously the first step is to make certain that the patient is in a safe position. He may, for example, be near machinery, lurniture or even have fallen into a pond; the source of danger must be quickly removed or the patient himself dragged away.

material like a clean handkerchief must be prepared, ready to slip between the teeth directly the con~ulsions begin. Its object, of course, 1S to prevent biting of the tongue and cheeks. During rigidity, the gag should not be forced between the teeth b~t if there is a gap, it can be placed 111 such a position that it can quickly be inserted when convulsions begin. Any time that remains during this can .be occupied by undoing t1ght clothmg, ensuring an adequate s~age

supply of air by keeping back bystanders, etc. Re-assurance of relatives and friends may be necessary since an epileptic fit can be a very unpleasant sight to witness; indeed the first-aider himself must keep calm and collected. During the convulsions, the gag must be adjusted and the patient's head supported so that injury is avoided. Otherwise no attempt should be made to control the convulsions. During the stage of recovery, the first-aider must make a quick examination to discover inj uries which require treatment; then the patient must be made comfortable in a suitable environment and encouraged to sleep. Observation of the patient is essential since he may have another fit. Occasionally a number of fits follow each other in quick succession a c:ondition called Status Epilepticus. Petit Mal In this variety of the complaint, the patient is ljable to short attacks of unconsciousness in which the eyes become fixed, the speech incoherent but there are no convulsions. These are often momentary and noticed only by the patient or a close observer. Indeed the patient may continue walking although perhaps developing a stagger, change of colour and feeling of faintness. Nevertheless attacks of petit mal are sometimes followed by post-epileptic complications.

. An improvised gag such as a penCIL or penholder covered with a soft

FIRST AID & NURSING, MARCH/APRIL 1955

Post Epileptic Complications These are of two varieties as follows :- (1) Automatism in which the patient performs actions which he COl1l10t remem ber afterwards and does not know what he is doing at the time. Thus, he may undress himself in public, attack bystanders or commit other unsocial conduct such as stealing objects near him. (2) MGI:ia is a variety of insanity. The patlent may become exciteable aggressive or even homicidal. Tem~ porary removal to a mental hospital ' may be essential.

Notes on a dvanced physiology By F. C. Reeve F.Z.S., F.R.E.S.

THE DIGESTIVE SYSTEM (Continued from the Jan.jFeb. issue)

THE act of swallowing is called 'deglutition,' but it is not controlled by gravity. Food does not fall down, otherwise it would be impossible to feed a patient lying in the supine position. It is a muscular action, but in passing from the mouth to the oesophagus the food is exposed to two possible dangers. It could pass down into the trachaea and cause choking or it could pass up into the nasal cavity. The first is prevented by the larynx moving upwards (watch the' Adam's Apple' of a person swallowing) and causing the epiglottis to close the glottis, and the second is prevented by the soft palate closing the passage to the nasal cavity. Occasionally, however, one or other of these two mechanisms do fail to operate, and we all know what happens when a particle ' goes the wrong way.' Should it pass into the nose cavity, then it sets up a kind of , spluttering' at the back of that organ, resulting in a flow of fluid.

It must not be supposed that when the' bolus' of food has passed into the stomach via the oesophagus that action on the carbohydrates has finished. This action can only take place in an alkaline environment, a condition which is fulfilled whilst it is in the mouth. In the stomach salivation continues for about 20 minutes, but the reaction of the gastric juices, which are acid, gradually brings this action to a close, although the whole of the starch has · not yet been converted into sugar. This will be completed later, but until then the carbohydrates '",ould be incapable of fulfilling their func-

tion of producing energy for work.

heat

and

From this point the processes of digestion become somewhat complicated, which is responsible for the fact that many students find it difficult to follow all the details. I propose, therefore, to follow a rather different order in describing these processes in the hope of simplifying some of the difficulties which experience has taught me are presented to first aiders and nurses. The secretions which enter into the processes of digestion do not all come from the alimentpry canal, but these are augmented by those from two large glands situated outside and some distance from it. These are the liver and the pancreas, both of whose functions we will now examine. The liver is the largest of all the glands in the bOGy and consists of a large number of lobules built up of specialised cells. It has many functions, but those which concern us here are the storage of glucose (sugar) in the form of glycogen, the conversion of part of the protein into fuel and the other part into urea, the secretion of bile and the preparation of fats for combustion. The bile is necessary to emulsify the fats as well as to stimulate peristalsis, the wormlike movement of the muscular walls of the alimentary canal which propels the contents onwards. The liver also assists in the production of erythrocytes (red blood-corpuscles .) The pancreas also consists of lobules which secrete pancreatic juice. This is composed of many elements, the principal of which are steapsin, amylopsin and trypsin, but more of these later. Now let us return tothe portion of food which we have been studying,

and which has now passed into the stomach, where it meets with the gastric juices. In the stomach there is alway~ a certain amount (about half a flUId o~nce) of gastric juice, but hen food IS on the way this is 1l1creased by a reflex action similar to that which stimulated the flow of saliva in the mouth. So far only the carbohydrate constituents of our food sample have been acted upon, but now it is the turn of the proteins and fats, but they must first of all be rendered acid, and this is effected by the hydrochloric acid which forms part of the gastric juice. The other two principal factors which go to make up the gastric juice are the ferments pepsin and rennin. Pepsin acts upon the proteins by breaking them down into simpler substances called peptones, which are more soluble. Rennin is a ferment which curdles milk, forming casein, which is milk-protein. This can then be acted upon as a protein by the pepsin. Hydrochloric acid also acts as a mild antiseptic, preventing infection by certain germs which enter with the food .

During these processes the contents of the stomach have been subjected to a churning action known as 'peristalsis,' which, in addition to assisting their mixing, has tended to render them semiliquid, and in this condition (it is caned' chyme ') they pass on through the pyloric opening into the duodenum. It is in this section of the alimentary canal that the fats begin to be acted upon, but chiefly by ferments which have their origin outside the duodenum. These are the bile from the liver and the pancreatic juice from the pancreas, and, although the chyme is acted upon chiefly by the pancreatic

FIRST AID & NURSING, MARCH/APRIL 1955

J Ulce, this action must be assisted

by the bile, which emulsifies the fats thus hastening their absorption. It has already been stated that the pancreatic juice contains three elements. Steapsin is the one which acts upon fats , breaking them down into fatty acids and glycerine. Trypsin continues the action commenced by the pepsin in the stomach, but it is much more powerful. We have seen that the conversion of starch into sugar was incomplete when the food left the mouth, and, although continued for a time in the stomach, the action was still not completed. In the duodenum another ferment, amylopsin, begins to act upon the starches and, being far more powerful in its action than ptyalin, can break down not only the cooked starches but the uncooked also. In the intestines digestion may be said to be completed, for it meets

there a complex substance, the succus entericus, consisting of several ferments, and it is then rendered sufficiently soluble to be absorbed. The walls of the intestines are traversed by a vast network of capillaries through the walls of which the intestinal contents (with the exception of the fats,) now liquefied, pass. These capillaries then unite to form the portal vein which conveys the contents to the liver. Here the glucose (sugar) is stored as glycogen and distributed as required by the body whilst the products of protein digestion are converted into urea and material for body-building and repair. The fatty acids and glycerine into which the fats have been broken down are absorbed by specialised cells and carried away by the lymphatic vessels, eventually to reach the blood-stream. These are the chief sources of the body's heat. There still remains in the small intestines a residue of waste material,

, roughage,' which is of no use in the economy of the body, and this is carried on until it reaches the i1iocaecal valve guarding the entrance to the large intestine. It consists of salts, cellulose (which is indigestible,) and a large proportion of water, for the whole mass is fluid. The walls of the colon secrete an oily substance called 'mucin' which acts as a lubricant, for, as the mass, now called 'faeces,' passes along the colon the water is absorbed by the walls and it gradually becomes more solid. Should it, for any reason, be hastened in its passage through the colon, thus retarding the absorption of fluid, then defaecation assumes the character of diarrhoea. On the other hand, if the faeces have become hardened, then the introduction of an enema will have the effect of distending the walls and thus setting up a reflex action through the brain centres, thus stimulating the desire to defaecate.

ubereulosis

by W. James Wright, S.R.N., B.T.A.

TUBERCULOSIS is an infectious disease caused by the tubercle bacillus, which is a small rod-shaped organism, visible only with the aid of a microscope. The organism is enclosed in a waxy envelope, which protects it from ordinary chemicals capable of destroying the average type of organism. There are four types of tubercle bacilli, but only two types are found in humans :(a) The human type which is largely responsible for causing pulmonary tuberculosis. (b) The bovine type, which is derived from infected cattle and is responsible for most cases of glandular and bone tuberculosis. Both types produce the same effect on the human body. Any part of the body may be attacked once the germ has gained

entry, and the two main routes of entry are the respiratory tract and the alimentary tract. Tuberculosis of bones, the meninges, kidneys, etc., is usually secondary to infection of the lungs or intestines. Usually the tubercle bacillus cannot live in the stomach as the gastric juices quickly destroy it, but one may be fortunate in getting through into the intestine to set up infection. Primary Focus The primary focus is the first infection of the body by the tubercle bacillus. An inflamed area arises around the offending organisms and the glands in the hilum of the lung may become infected in the case of pulmonary tuberculosis. In most cases the condition passes unnoticed, and eventually resolves leaving a small calcified scar. I~ some cases, however, the primary

There are certain factors which make the body suitable for the multiplication and activity of the tubercle bacillus. These are :(a)

Heredity. - Tuberculosis is not a true hereditary disease, but a child of an infected parent, particularly the mother, has a low resistance, and is therefore a likely prey for the disease.

(b) Age.-Tuberculous meningi~is is usually the cause of death 111 infants who contract the disease. I n adult life the common ages for contracting the disease are from 5 years to 24 years of age in females and from 5 years to 50 years of age in males. (c)

Sex.-On the average more males than females are affected with tuberculosis, especially among adolescents.

(5)

Local Symptoms Local symptoms are those which are found in the chest.

Course of Disease When the tubercle bacillus settles in the body it begins to multiply. The body defences immediately come into action and the organisms are surrounded by an area of inflammation. The tissues in the immediate vicinity are crowded with white blood cells. The toxins (poisons) liberated by the tubercle bacillus, kill the infected tissues, together with many of the defending white blood cells. The blood supplying the area becomes cut off, thus causing death to the centre of the area. The dead tissue has the appearance of cheese and this process is known as caseation.

(1)

Cough, which in the .early stages, tends to be persIs~ant and irritating, with very lIttle sputum.

(2) Sputum.- During the e~rly stages of the disease very ltttle sputum may be present and this may consist of watery mucus. As the disease progresses, however, the sputum tends to become muco-purulent and numular (coin-like). (3) Haemoptysis.-This may vary

from blood-stained sputum to severe haemorrhage.

(4) Pain.- As lung tissue is insensitive to pain this is not a marked sign of pulmOl::a~y tuberculosis, except where I~ IS accompanied by dry pleurIsy,

Dy_\pnoea.-This is a common symptom of pu1monary tuberculosis and is due to fibrosis and loss of elasticity in the lung tissue. It may be due also to displacement of the heart by the distorted lung tissue.

General Symptoms These are due to toxaemia (poisons in the blood-stream). (a)

General malaise. This is a state of mental and physical exhaustion, which eventually causes irritability.

(b) Loss of weight which persists.

(c) Lassitude, which increases. (d) Digestive disturbances, such as heartburn, and loss of appetite. (e) Fever, due to the toxins circulating in the blood-stream.

citrate. This is then drawn up into a special, graduated glass tube, placed upright in a stand, and at a stated time, usually after one hour, it is examined. It will then be found that the solid part, the red cells, have dropped or sedimented, leaving a column of clear fluid which is measured in millimetres. In health the column of clear fluid is from one to ten millimetres, but in active tuberculosis or other toxaemic -conditions it may be as much as one hundred mil1imetres. A history of the patient's health will be a great help to the specialist and contact with a known case of tuberculosis should especially be reported. Treatment of Pulmonary Tuberculosis There is, to date, no specific cure for pulmonary tuberculosis, but the aims are :(1) To increase the patient's resist-

ance, and keep it at a high level.

(f) Tachycardia, rapid heart action and pulse beat due also to toxaemia.

(2) To limit the spread of the disease and promote healing of the diseased areas.

Sweating, ~'~mmo nly referred to as ' night sweats,' but may occur at any time during the night or day, and amount to profuse sweating while at rest and in a normal temperature. It is due to instability of the heat regulating centres in the brain.

(3) To reduce the activity of the organism, and to prevent its reproduction.

(g)

Symptoms of Pulmonary Tuberculosis The symptoms of pulmonary tuberculosis are divided into two groups, local and gen~ral, but they may not all be present III every case.

focus, instead of resolving, spreads into a generalized condition.

This central area of caseation, which contains dead cells and tubercle bacilli, surrounded by an

or by fibrosed tissue pulling on other structures such as the pleura.

inflammatory area, is the part referred to as the tubercle, the bacilli being the organism.

(d) Social Conditions.- Bad housing, poor food, anxiety and poor working conditions.

Pulmonary

FIRST AID & NURSING, MARCH /APR1L 1955

(h) Amenarrhoea (abnormal absence of menstruation) in females.

Examinations Required for ~iagnosis If pulmonary tube~culosis is ~us pected the patient WIll be reqUlred to have a thorough medical examinination by a special~st .in che.st diseases. Other exammatlOns WIll have to be carried out, such as chest X-rays and pathological examination of the sputum and faeces for the presence of tubercle bacilli, although examination of faeces may not be requi red. A special blood test will also be performed, known as th~ blo.od

sedimentation rate (B.S.R.), III whIch 1.6 cubic centimetres of the patien(s blood is mixed with 0.4 cubic centImetres of 3.8 p.c. solution of sodium

The basis of the treatment is rest, by general rest, and ?y rest of th.e lung itself, by surgIcal means If necessary. The amount of rest required depends on the amount of damage to the lung tissues. Plenty of fresh air is essential with as much openair life as possible. Fresh air stimulates metabolism and in this way increases resistance. Food plays a big part in the treatment of tub:rculosis. A good well-cooked dIet should be given, besides wh~ch the patient should have extra mIlk and fat. Drugs are used extensively these days and even though they do. not cure, they help to increase the patIents body resistance, and help to weaken the offending organisms. The chief drugs used today for the treatment of pulmonary tuberculosis are :-. (1) Streptomycin, whic~ is nonnally given by injection 111to a large muscle such as the buttock.

FIRST AID & NURSING, MAR CH/APR IL 1955

Pulmonary Tuberculosis (Continued)

(2) Para - amino - salicylic

acid (P.A.S.) given by mouth, and is in liquid and tablet form.

(3) Isonicotioic

acid hydrazide (LN.H.), which is also given by mouth, in tablet form.

Occupational Therapy The patient must have some form of occupation to keep his mind at rest, otherwise he will worry either about himself or about things at home. Occupational therapy plays a big part in the treatment of tuberculosis. Needlework, knitting, and even reading helps the patient to forget his troubles. Everything possible should be done to ensure a contented mind, as worry will prevent or retard recovery.

The Institute of Civil Defence Gerald Drewitt, President of the Institute of Civil Defence, presented a silver goblet to Cauualties Union on the occasion of the Annual General Meeting of the Institute. The goblet to be know as ' The Institute of Civil Defence Trophy' is for annual competition at the Union's Open Competition in First Aid and Diagnosis. In expressing thanks for this recognition of the Union's work, Eric C. Claxton , founder and Chairman of Council. said that the Casualties Union grew out of the special needs of Civil Defence during the war. It was necessary for Civil Defenders to have experience in handling injured persons because the methods of handling must vary according to the condition of the patient as well as his injuries. The Union had provided trained , patients' whose behaviour was closely modelled upon actual cases so that students could obtain experience during training in preliminary diagnosis, immediate aid and handling of a great variety of cases. The wartime members were all Civil Defenders. Since the war the Union had developed on wider lines and had assisted The St. . . John Ambulance Brigade, The BntIsh Red Cross Society, St. Andrew Ambulance Association, Police, Fire Service, R.A.M.C., R.A.F., R.N. shore establishments, Coal Industry, Transport, National Hospital Service Reserve and Civil Defence Corps with First Aid, Nursing and Rescue practices. The Union was wholly voluntary and its services were available in parts of South Africa and Canada as well as in the United Kingdom.

FIRST AID & NU R SING, MARCH/APRIL 1955

* First-Aider~s Crossword No. 16 Com p iled by

w. A . Potter

RLJDODOLJOORLJODOLJ [JRORORORORORORO EJOOOOOOOOOOOOOD ORORORORORORORO EJOOOREJOOOOOOOOO OROREJRORRRORORO R.EJOOOOREJOOOOOO EJ.RRORORORORR.O [TIOEJOOOOREJDOO~RR ORORORRROROROREJ EJOOOOOEJOOOREJOOO ORORO.OROmEJmOmO EJODDOOOODODOOOO omo_omomomomomo EJOODOmEJOOOOOOom ACROSS 1. Often seen preceding shock (8) 6. This could be fatal in first-aid (5) 10. The draw inartistically (6,9) 11. Rather old-fashioned (4) 12. Came across a -,"!Otoring friend in the hand? (to) [4. Resistant micro-organism (5) 15. Fine linen (7) 17. Aim when bandag;ng. There's an examination at the end ... (7) 19. Hitch in treatment of fractured ann ... (5) 22. This nurse will have spotlessly clean surgery despite her beginning (10) 24. Could this be la::t substance in body fluids? (4) 26. For which the first-aider should always be prepa red '" (9,6) 27. Clementine's shoes (5) 28. Formerly associ~_ ted with the barbers (8)

DOWN 2. Action of aperient on bowels . .. (7) 3. A crooked inch below the lower lip (4) 4. A stern peer becomes upset to illustrate this (9) 5. Legs in hectic rural practice (5) 6. Dentist's withdrawal ... (to) 7. Prescriptions ... (7) 8. Inflammatory condition clears up without pus forming (8) 9. Does this bone enlarge in the unintelligent? (5) 13. Tee-total football teams? (5,5) 15. Can be cure for pirate (9) 16. Beginning of surgery ... (8) 18. Usually a surgical emergency when' acute' (7) 20. State of great joy (7) 21. Even the N.B.T.S. can 't get blood from this! (5) 23. Brings up a child backwardly? (5) 25. Pain from gorgonzola cheese . .. (4)

SOLUTION TO CROSSWORD No. 15 ACROSS DOWN 1, Frost bite; 8, negroid; 9, dietician . 1, Fade; 2, open ; 3, thin; 4, imitate; 10, still; 13, taxis; IS, pangs; 16, malice; 5, ennui; 6, brittleness; 7, dislocation; 17, cello; 19, scurvy; 20, tenets' 21 11, vaccination; 12, aggravation; 14, chyme.; 23, snivel; 24? Aston; 25, Edith; smote; 17, cycle; 18, lay; 22, m utates; 27, state; 31, attentIOn; 32, coroner; 26, dwarf; 28, snip; 29, pill; 30, once. 33, fast p,ulse.

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FIR ST AID & NU R SING, MAR CH/APR IL 1955

News and Notes Aids for the Disabled The British Red Cross Society recently held an impressive exhibition of aids for the disabled, at their headquarters in London. The gadgets comprised manufactured products and private inventions and ideas, and included the following: elastic shoe laces, stocking puller-on , long-handled lipstick, tap turner-on, padded potato peeler, egg holder, drinking aid, mouth page turner, various writing aids, telephone dialling aid, safety razor in metal holder for patient unable to grip, embroidery frame, beaker holders, door knob turner, etc., etc. The Society always welcome suggestions and new ideas for this important work. Newark and District Ambulance Society The annual First Aid Competition organized by the Society for the ' Ringrose Cup,' was held in the Newark Technical College, on Sunday, 20th February, 1955. For the third consecutive year the Newark Police team won the trophy, the other competing teams were: British Railways. ER., East Midlands Electricity Board ; B.EA. Stay thorpe ; Newark Nursing Division , St. l.A.B . ; Newark Ambulance Division, St. J.A.B. ; The Nursing Division who were competing for the first time, put up a good display and members of the aud ience passed comments on their gentle handling of the casualty.

Cadet Competition Two Ambulance Cadet teams and one Nursing Cadet team St. J.A.B., competed for the' Vickers Cup, ' the Nursing Cadet team competing for the first time adopted a realistic attitude in exposing the injury. Only the prompt intervention of the Judge prevented a pair of trousers from needing First Aid. Presentation of Prizes Dr. W. H. Valentine, O.B.E. , Divisional Surgeon, Newark Ambulance Division, Chairman of the Society introduced the Mayor of Newark, Councillor G. Walker, who presented the Cups and prizes to the winning teams He also presented the 'Crouch Cup' awarded to the individual with highest marks in the individual test to Mr. E. Robinson, British Railways, E.R. The winners of the Cadet Competition, Ambulance Cadet team ' B ' each received a~ additional prize of a propelling pencil, gIven by Area Surgeon Dr. J. F. D. Boyd, S.B.SU. , who also judged the floor test and Corps Staff Officer L. Ashmore who judged the individual tests. Meritoriolls Service Certificate Area Commissioner A. Hill , O.B.E., S.B.SU., presented the first Meritorious ~ertificate of the SU.A.B., ever awarded m the 43 years of the Brigade in Newark to Sub. Off. H. Cree, Notts City Fire Service Newark Fire Station. Mr. Cree a membe; of the Fire Service Detachment, attached to the.Newark Ambulance Division, whilst on ~ohd~y last year rescued a boy from droVlinmg m very rough seas. He was also presen~e~ wit~ the Long Service Medal of the BntIsh Flre Service by the Chief Fire

Officer of Nottinghamsbire, B. W. R . Smith. Cdt. D iv. Supt. F. Crouch, donor of the 'Crouch Cup' received his bar for 25 years service with the SU.A.B. The first President's and Vice-President's Badges of the Newark Ambulance Division were presented during the afternoon to Div. Sgn. Dr. E Ringrose (ret'd .), S.B.SU., President; Senior Vice-President Div. Supt. H. Reed (ret'd.), S.B.SU., and a founder member of the Newark Division received his badge along Vliith Mr. A. Tutt, Junior Vice- President. The Society's Secretary, R. Bridges, received the Bar for 25 years service in The Railway Ambulance Movement. Workjng to Lengthen Human Life A Hungarian doctor of medical science and his wife are working to prolong human life. The first big step in their researchesdiscovery of a new enzyme-has been honoured by the award of a £1,000 Kossuth Prize. Dr. J6zsef Ba16, Director of No. I Institute of Pathology, and his wife Ilona, have been working together for a number of years to find an answer to arterio-sclerosishardening of the arteries. Arteries are lined with a resiliant fibre which might be likened to rubber. In old age the fibre becomes hard and does not renew itself. The two Bal Ds discovered that an essential material for the regular renewal of the fibres is secreted from the pancreatic gland. They have named it elastase. If the pancreas does not produce elastase then hardening of the blood vessels sets in. They are now working out ways of putting their discovery to practical use. They have succeeded in making an elastase extract from the pancreas of cattle and the next stage will be to prepare a suitable medicine to enable human beings to fight hardening of the arteries. British Railways (Western Region) British Transport Commission Police First Aid Competition-1955 The South Western Area Eliminating Competition was held at Old Oak Common Hostel, and the following are the results :_ No. of Marks Max . 400 Dover 330t Exeter 303 Taunton ... 300 Southampton Docks 286JPlymouth 272t Bristol 249~. The adjudicators were Doctor E. J. Selby, of London, and Doctor C. T. Newnham. W. W. Wood, Chief of Police South Western Area, presided at the presentation of prizes which took place at the termination of . th~ contest, and was supported by tbe adJudIcators, W. G. Canning, Assistant to Regional Establishment and Staff Officer E. C. Brashier, Assistant Chief of Police' and l. A. Martin . Regional Ambulanc~ Secretary. The prizes were presented by Mr. Wood.

The Dover team will represent the South Western Area in the National Competition organized by the St. lohn Ambulance Association, which is being held at the Central Hall, Westminster, on 20th May, 1955.

Women's First Aid Competition This competition was held at Old Oak Common Hostel, and the Class 1 (advanced section) was won by the Newton Abbot team and Class 2 (beginners' section) by Cardiff. Doctor M . M. Scott, London, was the adjudicator in the team test, and Doctor C. J. P. Seccombe, Southall, in the individual tests. The subsequent proceedings were presided over by H. H. Phillips, Assistant General Manager, and the trophies and prizes were presented by Mrs. Phillips. S. G. Ward, Assistant Regional Establishment and Staff Officer, proposed a vote of thanks to the adjudicators, patients, stewards, etc. , and Miss E. A. Titcombe, captain of the Swindon team, a vote of thanks to Mr. and Mrs . Phillips. The Newton Abbot team has qualified to compete in the British Railways, Docks and London Transport (Railways) Competition for Women, which is being arranged by the St. John Ambulance Association at the Central Hall, Westminster, S. W.1, on Friday, 20th May, 1955. General News Cardiff Goods presentation of awards was presided over by J. Turberville, Assistant Goods Agent, and the awards were presented by H. Bastin, District Commercial Manager, who outlined the history of the movement and its very early connections with the Great Western Railway, and said that he hoped that renewed enthusiasm would result in an influx of new members. Other speakers were Mr. Slade, Assistant District Commercial Manager, and R. A . Newson , District Ambulance Secretary. Cardiff Queen Street long-service awards to members of the class were presented at the Annual General Meeting by the ViceChairman, E . A . Abel. Cheltenham Spa (St. lames') annual din ner was held at the Star Hotel. T he President, R. H. B. Nicholls, District Operating Superintendent, paid tribute to the work of the Corps, and congratulated the members upon having recruited new entrants into the movement during the past seven successive years. Among those present were C. Wright, District Engineer, A . W. Sheppey, Assistant District Commercial Manager, F. K. Coombes, Assistant District Operating Superintendent, K. G. H. Parkinson, District Road Motor Engineer, W. M. Short, Station Master, L. M. Starr, Goods Agent, Gloucester, F. C. Lewis, Goods Agent, Stroud, T. C. B. Davies and W. E. l. Perks, District Ambulance Secretary. The evening concluded with old-time dancing and games, under the direction of G. Maisey, the arrangements for the (continued on page 14)

W hen you receive a wound or

activities-and thus themselves slow down the process of healing.

burn, your body mobilizes its

(Furacin' , however, is an entirely new type

repair squad to make good the damage. Infection by bacteria hinders the repair squad in its

of germicide, which destroys bacteria and prevents

work and may even overwhelm it, so that the wound

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heals slowly or not at all. So infection must be pre-

squad unharmed to get on with healing the wound_

vented or suppressed, and this some of the older

For this reason, ( Furacin ' is becoming more and more

antiseptics do quite effectively.

widely used in hospitals and first-aid rooms in this

But no antiseptic, however efficient, will heal a wound; only the repair squad can do that. The drawback of

country and America. Made up as an ointment, it IS easy to handle, and

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FTRST AID & NURSING, MARCH/APRIL 1955

News and Notes (continued) evening being in the hands of the class secretary, G. Walker. The Grand Priory in the British Realm of the Venerable Order of the Hospital of St. John of Jerusalem The Investiture was held by the Lord Prior, Lord Wakehurst, K.C.M.G., Governor of Northern Ireland , in the Great Hall, St. Bartholomew's Hospital, London , E.C.l, on Tuesday, 15th March, 1955. Exchange of Medical Publications Medical libraries throughout the world, which previously offered their surplus publications to other medical institutions for free distribution and exchange through UNESCO, will now offer them through the agency of the World Health Organization, Geneva. , WHO' will inform medical libraries in its Member States concerning the availability of medical books and periodicals offered by libraries. It will not itself collect and make shipments of such material but will act as a central information servic~ for medical libraries wishing to exchange and distribute mater ial. All shipments of publications will be made directly from one medical library to another, after agreement has been reached on the exact items required and on the question of the transport costs. , WHO,' through its Library and Reference Section, is already in touch with a great many medical libraries throughout the world, but will be glad to receive from new medical libraries offers of exchanges accompanied by lists of the most needed books and periodical parts. Coloured Students in First Aid . So k~en were coloured students taking a FIrst Aid course, to pass the examination, that they even took home bandages in order to put in extra practice. The result ? They all passed with a very high standard indeed. This story of keenness is the result of the scheme whereby the St. John Ambulance Brigade hopes to interest coloured students over here i? England, in First Aid and Home Nursrng, so that they may take back knowledge which will be of use to them and to !heir communities, when they return to then home countries. The first course was attended by eleven students, from ~j~~ia , Malaya, Sierra Leone and the PhillJpmes. The examining docto! (Dr. H. C. Stewart of St. Mary 's HospItal) remarked on the high standard reac~ed by all the candidates, and this desP.lte the fact that they had their own studles to pursue at the same time. Casualties Union Buxton Trophy.-Entries are invited for aT? Op~n Competition in Diagnosis and Flfst Aid to be decided at New Gas Works Ponders End, Middlesex, on Sunday, 2nd 9ctober, 1?55 .. O~ing to the increasing lD~erest whlc~ .IS b~lDg shown each year in thiS COmpetItIOn, It has been decided to hold regional eliminating rounds on Sunday, 10th July? 1955. The winning teams from .e~ch regIOn to compete in the final. Enqumes to the Competition Secretary Casualties Union, 8 Woodcote Park Avenue, Purley, Surrey.

Ileatlers~

queries Answered by Dr. A. D. Belilios

F. C. (Brixton) writes : At a recent St. John Divisional meeting a discussion arose regarding the interpretation of the S.J.A.A. Text Book, which states on page 149 'That when both legs are fractured and no assistance is available (4) Tie the ankles and feet together, (5) Apply bandages around both limbs as in Fig. 105.' Some are of the Opl11l0n that this means two figure of eight bandages should be applied, but 1 think that only one is indicated. If, however, two figures of eight are intended, what is the purpose of the second one? Answer I personally would use two figureof-eight bandages. The first supports the injured limbs while the other bandages around both limbs are being applied. The second gives additional support around the feet and ankles-a very important situation.

E. B. C. (Dover) writes : A tragedy has occured in our works. One of our younger workers went home one evening fit and well but was taken ill suddenly in the night and died within a few hours. The cause of his death has been announced as a ruptured aneurysm of the brain. Can y ou give me some information as to what this means ? Answer An ~neuryism is a kind of a bulge occurnng along the course of an artery associated with weakening of the coats of the bloodvessel. It can ~e a con~enital condition or develop m later hfe. Such an aneuryism can burst at any time giving rise to fatal apoplexy. Fortunately many cases recover and in any case the condition in young people is uncommon.

S. E. B. (Salisbury) writes.:A question asked in the last issue on the treatment of dual injuries has intrigued me, and has made me wonder what first aid you would recommend for a patient who has a complicated fracture of his right ribs combined with a fractured clavicle on the opposite side. Answer The complicated fracture of the ~i~s must be considered the priority mJury and the recommended first aid applied. So far as the clavicle is concerned, sufficient support will be supplied by securing the limb to the tru~k by one or two broad bandages, taking care, however, that they are not secured near the broken ribs. The. treatmeI?-t of shock and early medIcal adVIce are obviously of paramount importance.

G. L. G. (Cardiff), writes Page 110 of the S.J.A.A. Manual advises for the treatment of bruises appl};ing lint soaked in equal parts of spzrzt and water. What kind of sprit should be used and what is its object ? Answer Any kind of spirit will domethylated, surgical or, if you want ~o be generous, whisky! The point IS that when spirit is mixed with water, an evaporating lotion is made which, when applied to the affected par~, produces cold, thereby redUCIng swel.ling, limiting bleeding under the skm and relieving discomfort.

F. R. R. (Manchester), writes :_ Before I was married I was in a Nursing Division. Now I have five children and my knowledge of HomeNursing has become rather rusty. I wonder why, in some feverish illnesses, my children always seem to become worse at night causing alarm to myself and husband and apparently annoyance to the doctor whom l'phone up when I want advice? Answer The normal temperature of the ~um~n body is not98.4 as most people Im~gIne. .it shows a regular daily SWIng? bemg lowest in the early mormngs when jt is often subnor~al and then gradually rising dunng the day to reach its maximum between 6.an~ 9 p.m. in the evenings. In a fevensh Illness this swing is still

FIRST AID & NURSING , MARCH/APRTL 1955

present or even increased hence the temperature may be considerably above normal in the evenings with consequent worsening of the patient's condition causing 'alarm to the parents and annoyance to the doctor' which the latter expects you to know this. ComI11unicate with him early in the day rather than leave it until the evening when he himself may want to relax.

other places, over bony prominences of the body, e.g. the elbow etc. It acts like a little water cushion, facilitating movement of part on part. Housemaid's knee occurs when the bursa over the knee-cap becomes inflamed and forms a swelling which is red and painful.

N. D. B. (Exeter) writes One of the workers in our factory is away and has sent in a certificate which states that he is suffering from prepatellar bursitis. 1 understand that this may be caused by his work and should be very interested to hear more about the condition. Answer Prepatellar bursitis-or housemaid's knee as it is often called- is not uncommon in those who have to kneel in the course of their jobs. A bursa is a little bag of synovial membrane (a tissue just like that which lines a joint) found, amongst

K. M . (Maidstone) writes :J am in the ambulance service and am often responsible for moving heart cases to hospital. Are there any general rules which govern the position of the patient during transport ? Answer The doctor ordering the ambulance may of course give instructions but in the absence of such advice you must use your own discretion. If, for example, the patient is bluish in colour (cyanosed) and short of breath as occurs in cases of heart failure, he must be kept well propped up in an almost sitting position. When, however, the face is pale and shock is present as in coronary thrombosis, a more recumbent position is advisable .

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Nursing Eclltor: Peter I. Craddock This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd. , 32 Finsbury Square, London, E.C.2, for the purpose of proyiding an informatiye technical serYice on first aid and nursing. We welcome contributions.

May/June 1955

In this Issue New Arrangement for Competition Sets Combined First Aid Exercise Infantile Convulsions 2 Forthcoming Events ... 3 The Stanley Shields B. R . C. Competition Finals 4 B. E. A. C. Competitions 6 Metropolitan Women Police Competitions 7 London Transport Competitions 8 From a Seat in the Audience 9 New Type of Aluminium Stretcher 10 First-aider's crossword 12 12 Readers' Queries

Do yo" know that • .• 1. The average life of a n erythrocyte (red blood corpuscle) is from 3 to 4 weeks ? 2. The , ascular changes (seen as redness on the surfa ce of the skin), whi ch take place in acute inflamm ation were fi rst described by Colnheim in 1877 ? 3. One-fourth of the we ight of norma l faeces consists of dead bacteria ? 4. Rhazes, an Ara bian surgeon (850932 A.D. ) used plaster (lime and white of egg) for setting fra ctures of the long bones ? 5. M uscles are seldom attacked by the tubercle bacillus ? 6. The contents of the small intestine are propeI1ed at the rate of ] in. per minute ?

F. 1-\. Trott.' the genial sec~etary of the Southern Region (British Rallwavs) Ambulance Centre, IS nothlllg If not. ongInal. It has formerl) been the practice in the major compe~ltl?OS to hol~ t~e vanous t~sts-team , dual, individual, etC.-in different rooms of a bUlI~l~g, oecesslta~lOg a cO~tlOUOUS promenade of spectators from room to room remlOlscent of th~ mterludes 10 Mussorgsky's ' Pictures from an Exhibition.' It occurred t~ Mr. Trott that If ~11 the ~ets cou ld be arranged in the centre of one large hall many of the dlsadvant~ges assoClated w1th the former sC0-eme might be eliminated. On 29th April, on the oc:caslOn of th~ S,outhern RegIOn (Bntlsh Railways) Finals held at the Brighton Aqu~rn:m, ?e had his big chance. , In the team test to-e s~e.ne consisted of scaffolding outside ~ building 10 course of construction. Of the four lOdivldual tests, one was set outside a bus shelter on a country road, the next was represented as taking place on the top of a cliff the third was in a ' garage and the fourth had a railway station for its backSTATION SET ground. Formerly these would have required no less than A three or four separate rooms, but the A " ingenious idea dePYLON. vised by Mr. Trott enabled the five sets STATION SET to be erected in the centre of the hall, each being divided off from the others by a partition. The space enclosed in CLIFFTOP SET the centre was used for administrative purposes and also served as a dressingroom for the __ , ~/-,-'--G-A-RA-G-E-S.../ET -"'C-OU-N-T-R-Y-S-ET-...( . patients.' The positions of the stretchers for the various BUs SH[LTE't. tests are worthy of attention, but the whole scheme can be better appreciKa A. REWLVING DOORS ated by means of the accompanying We sketch which has been kindly furnished by Mr. Trott himself. certainly recommend the arrangement to other organizing secretaries.

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Combined First Aid Exercise A number of national disasters during the past two or three years have drawn attention to the need for some organized system whereby assistance can be brought to the scene of any such disaster with the minimum of delay. Those who have studied the Ministry of Health Circular H.M, (54) 51, 31st May 1954, and Circular 13 /54 of the same date, will be aware of the arrangements which are being made by Her Majesty's Government whereby hospitals will be notified and preparations made for the recept ion of the injured. The Circulars deal, also, to some extent, with action on the spot. Major-General L. A. Hawes, C B.E., D .S.O., M.C., M.A ., Controller, H ome Department, British R ed Cross Society, feels that the various voluntary bodies-The British Red Cross Society, The St. John Ambulance Brigade, The

Women's Voluntar) Sen ice. etc.-could be of inestimable service if properly organized and co-ordinated, and he is no\\ engaged in working out the details of this scheme. Our representative was recently granted an interview by Major-General Hawes in which he explained his plans, which included pre-arranged rallying poiots. stores of stretchers and blankets, distribution of per onnel and the e, act method of cooperation with the Police, Fire. Ambulance and Railway authorities. Lt is hoped that the first large-scale exercise on these line will take place in the near future at Bedford, in conjunction with the Chief Constable of Bedford, when we look forward to publishing a detailed report of the proceedings. We are grateful to Major-General Hawes for this advance news.

FIRST AID &

COURSE IN

ELE~IE~~TARY

FIRST

RSI01G, MAY'JU rE

1955

AID

Unconsciousness-infantile convulsions By A. D. Belilios M .B., B.S. (Lond.), D.P.H . (Eng.)

D URI G the past few months,

we have been concentrating in this series on the causes and treatment of unconsciousness ; there remain quite a few ailments which are accompanied by insensibility and some of these will be described in this article. Infantile Convulsions These are the fits which occur in infancy and early childhood, causing much alarm to anxious parents. They may be due to a number of causes; they are not uncommon as a mode of onset of infectious diseases such as measles, scarlet fever, etc., when they replace the severe attacks of shivering accompanied by a rise of temperature (rigors) often experienced by adults under similar circumstances. Quite a number of fits are due to reflex causes, i.e., sources of irritation within the body such as digestive disturbances, earache, worms, etc., while, occasionally even in young people they may be epileptic in origin. From the aDove it will be readily understood that infantile convulsions are usually signs of an underlying ailment; hence, strictly speaking, they should be classified as secondary causes oful1consciousness. Another fallacy should also be mentioned. One often hears said that a patient has died from convulsions. Actually what is really meant is that the patient had died from an illness of which one of the signs is convulsions. Symptoms and signs: Warnings often precede the actual fit. Thus the child may appear irritable, restless and' jerky' while the characteristics of the causative ailment may be present, e.g., those of fever, etc. The convulsions begin suddenly. The child's body becomes stiff and its head is thrown backwards. The breathing becomes irregular and may even stop momentarily. The colour changes and varies from pallor to marked blueness. Twitchings and tremors of muscles may be observed in various parts of the body but true convulsions such as occur in

real epilepsy do not usually occur. Frothing of the mouth and squinting may occur. There is a widespread misconception as to the meaning of the word 'squint.' Many confuse it with blinking of the eyelids-a totally different thing. A squint refers to one or both eyes turning inwards or outwards and no longer remaining parallel with each other. In other words the eyes become , out of the true.' In infantile convulsions the squint is purely temporary, but in long sight, children often develop a permanent squint of one eye-usually inwards-which can, however, be corrected by glasse~, exercises and, if necessary, an operation. First Aid: Immediate reassurance of the parents that there is no cause for alarm is most desirable since they are hable to become very distressed and fear the worst. The child may be stripped and supported up to the level of its neck in a hot bath (temperature about 100 OF.) while cold compresses are applied to the top of its head. This treatment should be continued until the doctor arrives or for the duration of the fit after which the child should be dried, wrapped in a warm blanket and the head still kept cool. The general principles for the treatment of unconsciousness should be carried out as far as possible. There are many doctors, however, who do not agree with the above treatment. They believe in putting the child straight to bed, keeping it warm and applying the general principles with cold compresses to the head. Naturally the cause of the fit has to be investigated. Hysteria Most of the injuries and aiIments which a first-aider treats affect the body of his patient-thus fractures, wounds and head injuries are clearly related to the struct ure and organs . But it must never be forgotten that the human body also includes the mind which itself is liable to ailments commonly known as psychogenic

disorders. or by the general public as 'nerves : Tbere are. of course, many such illnesses but it is only intended to refer to hysteria in tbis article. Hysteria itself may take many forms such as attacks of unconsciousness, loss of voice, or even sight. Sometimes there is loss of use of part of the body such as a limb. A first-aider, however, must never diagnose any of these conditions as hysterical in origin. The doctor himself has to take the greatest care in excluding a physical cause before diagnosing one that is psychogenic. Hence the only hysterical condition about which the first-aider is expected to know is the' fit ' which may be little more than a fainting attack or violent outburst of temper. Sometimes the fit resembles epilepsy but with certain very important exceptions. Thus generally it only occurs when there is an audience and the patient does not usually hurt himself by his fall or during the , convulsions' ""hich may take the form of struggling, kicking, panting. Consciousness is not completely lost-indeed screaming and shouting may occur. There is no incontinence of urine or faeces and the colour of the patient remains good. First aid consists of treating the patient firmly and avoiding sympathy. Bystanders should be asked to leave the vicinity but observation should be maintained. Medical advice should be recommended since a form of treatment called psychotherapy given by a psychiatrist may do much to help the patient overcome the complaint. Diabetic Coma This is a complication of D iabetes, a disease which affects the pancreas . This gland has two functions (a) to produce a digestive juice which enters the duodenum and (b) to produce an internal secretion or hormone called Insulin. Insulin is made by groups of cells in the pancreas called the Islets of Langerlangs and is poured directly int o the blood stream. Its presence in

FIRST AID &

RS['\G, \.1 A Y J U~E 1955

the blood is essential since it controls the use of carbohydrates in the body, allowing the liver and muscle to burn glucose \\hich is a form of sugar used by the body as a fuel. If the Islets of Langerlangs are defecti e and fail to produce sufficient insulin. the tissues cannot make use of the glucose which is provided for them in the blood stream: thi glucose therefore is wasted and lea\'es the body in the urine. But the tissues must still have fuel and this they obtain by using extra fat. This however, does not burn completely in the absence of glucose \vith the result that toxic substances accumulate in the blood to such an e tent that they ultimately cause unconsciousness. Warning symptoms of coma include restlessness headache and sometimes pain in the abdomen. There is increasing drowsiness leading to coma and the breathing becomes distressed, even to the extent of air hunger. The breath itself often smells of acetone-i.e., of musty apples. First Aid: Treatment by a doctor is essential and is usually carried out in hospital where facilities for blood tests are available. The first-aider himself can only apply the general principles as far as any unconscious patient is concerned. If the onset of coma is suspected, hmvever, and the patient is able to swallow, water should be given liberally. Insulin Poisoning or O ver-dosage Diabetes is treated by dieting and by giving insulin, an extract obtained from the Islets of Langerlangs of animals. It is administered by injections which the patient learns to give himself once or twice a day. These injections have the effect of

lowering the amount of sugar in the blood. If the patient gives himself an overdose or omits to follow hi regular diet, he is liable to develop a number of ymptoms and sign which may lead to coma in severe cases. The characteri tics of over-dosage are extremely variable. A feeling of hunger with \\"eaknes and faintnes is common while often the patient"s behaviour changes and he becomes excited and emotional, giving rise to the suspicion that he is hysterical. It has been said that any sudden change in the manner of a patient taking insulin should be regarded as a warning of over-dosage. An important sign is s\yeating while sometime the patienfs hands are seen to be trembling and he complains that he can see double. In the severe cases coma follows, occasionally preceded by fits. A valuable clue in a doubtful case is the discovery of' prick marks' on the legs or arms where the patient i accustomed to giving himself iniections with a hypodermic syringe. First Aid: :M ost patients under trea tment \ ith insulin themselves learn to recognize the warnings of over-dosage and at once take ugar in some shape or form. e.g., s\\ eets, jam, sugar lumps, etc. This is the basis of fir t aid and if the patient has reached the stage of semiconsciousness this is the treatment to be followed provided that he is able to swallow; the swallowing reflex must be tested. Quick recovery is the rule in the average case. When coma has actually occurred and the swallowing reflex has di appeared. it is dangerous to give anything by the mouth and the firstaider can only apply the general principles for the treatment of un-

con ciousnes. A doctor's help ies entia 1 at the earliest po ible moment since gluco e ,yith saline may ha\'e to be gi\'en through a \ein. Uraemia The kidney. t\\ 0 in number. have a their function the excretion of urine. This con i t of water, alt and waste product such as urea which are eliminated from the bod\" by the urinary y tern. If the kidneys fail in their action, harmful sub tance accumulate in the blood and act upon the nen"ous system producing the condition called raemia. The ymptoms and signs are ver) variable and may include attacks of shortne s of breath and di!!estiYe disturbance such as naus~ea. yomiting and diarrhoea. But the variety o(importance to these articles is the cerebral type . Thi generally begins \,"ith a severe headache and i followed by drow ine and twitching of the face and hands, even amounting to fits like epilep y. The drO\\"sine deepens into coma \yhich is often accompanied by irregular breathing-there may be a smell like that of urine in the breath. First Aid: Patients sufferin!! from uraemia are u ually already ~under medical care which they have sought on account of \\'arning symptoms. In any eyent the condition may be difficult to diagnose and dependent on blood te t made by a doctor (pathologist) to determine the amount of urea pre ent in the blood. Hence all the first-aider can do if he suspect that he is dealing with a case of uraemia is to apply general principles and obtain medical assi tance as soon a possible.

Fortl.co,,,;,.g Ect!l.ts 24th June:

Ministry of Supply

ational First Aid Competitions, Central Hall, Westminster, commencing at 9.30 n.m .

2nd July:

ational Hospitals Service R eserve Mobile First Aid Units Competition,

3rd July:

ational R oad Transport Ambulance Association Competitions, commencing at 2 p.m.

Hor e Guards Parade, commencing at 2 p.m.

St. John Ambulance Brigade Competitions (' Dewar' and' Perrott' Shields), Central Hall, We tminster, commencing at 9th July: 9.15 a.m.

FIRST A I D & NU R S lNG, MAY/JUNE 1955

The Stanley Shields British Red Cross Competition Finals ONE of the principal events of the competition season is the British Red Cross Society's Finals for the Stanley Shields and other trophies which was this year held at Friends' House, Euston Road, London, in the presence of Her Royal Highness, the Princess Royal. The competitions consist of no less than 13 tests altogether, and the following table of the tests, together with the respecti ve judges, will give some idea of the magnitude of this event, for which a building of the dimensions of this magnificent edifice facing Euston Station is necessary : Women First Aid Team Test-Judges.' Surgeon Captain J. L. S. Coulter, D.S.C., R.N., Wing Commander W. Davies. Nursing Team Test-Judges: Miss J. Addison, Matron, Guy's Hospital, Miss B. N. Fawkes, Principal Sister Tutor, Middlesex Hospital. Officers (F.A.) Oral and PracticalJudge: Col. W. McKim McCurragh, D.S.O., M.e., T.D., F.R.C.S. Members (F.A.) Oral-Judge: Wing Commander H. L. Willcox, R.A.F. Members (F.A.) Practical-Judge: Col. G. M. Frizelle, T.D., M.D. Officers (H.N.) Oral and PracticalJudge: Miss D. Holland, Sister Tutor, Guy's Hospital. Members (R.N.) Oral-Judge: Miss D. A. Lane. Members (H.N.) Practical- Judge.' Miss W. E. Coombe, Matron, The General Hospital, Northampton. Uniform-Judges: Mrs. Harvia Wray, County Dir~ctor, Derbyshire Branch, B ..R.C.S., MISS M. Stockley, County Dlrector, Staffordshire Branch, B.R.C.S. Men First Aid Team Test-Jlldges: Group Captain J. Parry Evans, R.A.F., Lt.-Col. W. Windsor, R.A.M.C. Officers and Members (F.A.) OralJudge.' Lt.-Col. J. Kilgour, R.A.M.e.

Officers and Members (F.A.) PracticalSurgeon Commander F. B. B. Weston, R.N. Uniform-Judges.' Lt.-General Sir Neil Cantlie, K.e.B., K.B.E., M.e., F.R.e.S., County Director, Isle of Wight, B. R .e.S., Sir Franklin Gimson, K.e.M.G., K.SLJ., County Director, N. Riding, Yorkshire, B.R.C.S.

Judge:

The events of the day commenced at 9.15 a.m. with uniform inspections, followed by the various competitions, and lasted until late in the afternoon, concluding with the presentation ceremony. As always, the tests proved of a most interesting character, aU being set with a view to testing the knowledge and skill of the competitors.

Men's Team Test: The incident takes place in the storeroom of a large firm where men are engaged in stocktaking. One of the men is attempting to get down a crate from the top of a pile when it falls, bringing others ",ith it, crushing John Shorthand and also injuring James Scribe. Injuries-Shorthand: Fractured pelvis (uncomplicated), simple fracture of right humerus (middle third), severe shock, but conscious. Injuries-Scribe : Abdominal injury with internal haemorrhage, severe abrasion left lower l~g, conscious, but gradually loses consciousness in fifteen minutes, severe shock.

Women's Team Test .' One winter's afternoon the District nurse asks the team to attend two cases at Spoke Cottage as she has been called away suddenly. They find two elderly sisters confined to bed. Miss Hubb suffers from chronic rheumatism. Mrs. Wheel has been in bed for several days with laryngitis. Just before. the team arrives, a niece,Joan Wheel, calling to see her aunts, has shpped on the doorstep. Mrs. Wheel, alarmed,

The winning Kent men's team

has jumped out of bed and tripped over a mat. Both first aid and nursing procedures are indicated.

injuries (in addition to medical conditions) : Miss Hubb: No injuries, but distressed by accident. Mrs. Wheel : Sprained right ankle, incised wound of right forearm, moderate haemorrhage, slight shock. Joan Wheel: Colles' fracture of left forearm, simple fracture of left patella, severe shock.

Individual First Aid Tests (Officers) .' (1) Digital pressure of arterial haemorrhage associated with high compound fracture of left humerus where brachial artery cannot be compressed. (2) Crushed foot with lacerated wound of instep (moderate haemorrhage) using triangular bandage to retain dressing.

Individual First Aid Tests (Members) .' (1) Severe bleeding from tooth socket. (2) Fractured right patella. (3) Carbon monoxide poisoning. (4) Incised wound of palm of left hand with retained glass fragment, using triangular bandage to retain dressing.

Pairs First Aid Tests (Members) : (1) Simple fracture of left clavicle and abrasions of palm of left hand, using triangular bandage to retain dressing. (2) Simple fracture of left humerus, near elbow joint, using splints.

Individllal Nursing Tests (Officers) .' (1) Lay up for blood transfusion. (2) Apply doubJe breast bandage.

Individual Nursing Tests (Members) .' (1) Lay up for gastrotomy feed. (2) Lay up for immediate post-operative (3) Lay up for blanket bath. (4) Lay up and prepare to irrigate an eye.

FIRST AID & NURSING, MAY/JUNE 1955

Pairs Nllrsing Tests (Members) : (1) Change draw sheet with palient sitting up. (2) Change top sheet (measles). At 2.25 p.m. H.R.H. the Princess Royal arrived and, after inspecting the guard of honour, consisting of members of teams which had completed their tests, passed to the Great Hall, to witness some of the women's teams at work. From there she passed to the Minor Hall, where she watched some of the men's teams, for Her Royal Highness has always taken a personal interest in these competitions and always expresses a wish to see some of the actual tests. Shortly after 5 o'clock the scenery was cleared from the stage of the Great Hall and replaced by a long table, upon which was displayed the handsome trophies which had been competed for that day. The Chair was taken by the Countess of Limerick, G.B.E., L.L.D., who was supported by Her Royal Highness the Princess Royal, C.I., G.e.V.O., G.B.E., MajorGeneral L. A. Hawes, C.B.E., D.S.O., M.e., M.A., Controller, Home Dept., Miss M. E. Craven, R.R.C. (Matron-inChief), Miss M. aylor Smith, M.B.E., The Hon. Mrs. Balfour, Lady-in-Waiting, Mrs. A. M. Bryans, c.B.E., Air Commodore H. A. Hewat, C.RE., M.B., Ch.B., D.T.M. & H., Medical Adviser, Mrs. H. M. Hetherington, Staff Officer responsible for the organization of the Competitions. Amongst the many guests who had accepted invitations were to be noted : Order of St. John: Mrs. Grosvenor, C.B.E., Deputy Superintendent-in-Chief, S.J.A.B. Maj. A. C. White Knox, O.B.E., M.e., M.B., Ch.B., Mr. Horace F. Parshall, T.D., M.A., Director-General, S.J.A.A. Ministry oj Health: Mr. S. A. Heald. War Office.' Brigadier Franklin. Air Ministry: Air Commodore Lipscombe, and many others. Lady Limerick opened the proceedings by asking Major-General Hawes to announce the results, which were as follows : -

Women 1.

The winning Warwickshire women's team 3. 4. 5. 6. 7. 8.

Warwickshirel2 ... (winning the Stanley Shield) Cambridge:96 ... (winning the Hetherington Cup for Nursing, for women's team with highest marks) Devonshire/64 .,. Denbighshire/ 12 ... Dundeel4 Gloucestershire/42 Leicester/98 West Yorks /510

Men 1. Kentl87... 2. 3. 4. 5. 6.

... (winning the Stanley Shield) Nottingham/ IS Roxburgh/3 North Lincs/27 G loucester / 19 East Lancs/47

Marks 801 786J

782 771 744,}

no,} 670 662 816

771 7484 664.\· 618-

617

Additional Awards: Evelyn Wren Cup for officer with highest individual marks: Miss M. F. Berry (Devon /64). Georgina E. Morgan Bowl for member with highest individual marks : Mrs. J. T. Blackwell (Devon !64).

Margaret Gordon Harker Cup for team leader with highest individual marks: Mr. T. Campbell (Roxburgh /3). Lt.-Col. R. M. West Cup for member with highest individual marks: Mr. A. F. Thornton (Kent l 87). The Chairman then asked Surgeon Captain Coulter, who, together with Wing Commander Davies, judged the Women's First Aid Team Test, to give his comments. He commenced by saying that he was expected to tell the truth, and therefore he had to admit that he and his colleagues were disappointed with the work in this test. Last year some thought that they had been too severe, and they had received many letters to this effect, one correspondent writing from abroad because her girl friend, a member of one of the teams, had been criticised. This year the teams had been of a different type, and, although they were disappointed, they had to agree that they had seen some very fine work, and, compared with last year, the winning team had gained 40 marks higher than the maximum last year. The faults they had seen were, for the most part, minor ones. The leadership was admirable. They both congratulated the teams on the high standard attained, but hoped to see it higher still next year. Miss Addison was the next judge to comment, speaking for herself and Miss Fawkes, who had judged the Women's ursing Team Test. After referring to the magnificent work which the members of the B.R.e.S. were doing in places Ike Uganda, Nigeria and Kenya, places fraught with danger, and also to the fact that last year 600 recruits entered for General Nursing Training for the State Register, she passed to the work they had seen that day. They would have to be harsh again this year, but they knew that tbe competitors would not mind. Approach had been good, but leadership was weak. They felt that the team missed the real point of their visit to the sick room. Some did very well, others not quite so well. She mentioned as an example putting on bedsocks. The bed should have been stripped so as to give the nurses a clear field and they could then have moved her feet without hurting her. They had been impressed with the routine work, but they should observe the correct order in which it should be done, commencing with the taking of temperature. Bed-making was good, but, again, remember the C!rder of procedure. She concluded by hopmg that all teams would enter again next year, and emphasized the gratitude of the hospit.als for the help they were constantly gettmg from members of the National Hospital Service Reserve. The last judge to comment was . Group Captain Parry-Evans who, with ~t.-~oI. W. Windsor, had judged the Men s F~rst Aid Team Test. He commenced by noting the improvement in the work, and also commented upon the excellent acting of the , patients' who had been trained by the Casualties Union. The team leaders had improved, giving their i nst.ruct io~s and letting the members get on wlth their work without interference. ThiS showed the mutual confidence born of regular and long practice. When a member is compelled to ha nd over a. case to .a colleague he mLlst give full lnformatlOn before leaving. Elementary trUining, bandage

5 and knots were sometimes forgotte.,. Only three teams stiffened the stretchers. In inviting H.R.H. The Princess Royal to present the awards the chairman said that they were most grateful to Her Royal Highness for the very great interest she had always shown in the work of the British Red Cross Society. She had just returned from the West Indies where the Princess visited two years ago, and it was most gratifying to hear the comments which were made and to learn of the good effects of that visit. So keen were the native members in their work that they often attended [or voluntary work in the hospital at 5 o'clock in the morning before going to their own work on the plantations. She hoped that a record number of recruits for Civil Defence and the ational Hospitals Service Reserve would follow the visit of Her Royal Highness. 'The presence here of Your Royal Highness is a great stimulus to the work of the British Red Cross Society.' With a handshake and a kindly word to each member Her Royal Highness presented the awards to the successful winners, and then said : 'It gives me very great pleasure to be present this afternoon and once again to meet so many officers and members. I would like to congratulate all the teams who took part, winners and losers alike. Theirs has been a very high trial, almost more difficult, I sometimes think, than having to deal with a real accident. Exacting though our training may be, I am more convinced than ever that we must never relax the standards, not only of our instruction and examinations, but also of our tests and competitions. When faced with a real emergency there is no time to refer to the book or to cogitate as to what should be done. That our system is sound is shown by the recent action of two of our members. One girl of twenty-one, walking home from a dance, unhesitatingly went under a 'bus and saved the life of a man whose leg had been cut off. She was the only one present who knew what to do. The other case was of a man doing duty at a football match. Here the casualty had a broken neck and his life was saved because the first-aider recognized the signs and symptoms and knew exactly what to do. He also had the powers of leadership to enforce his treatment and prevent possible mishandling which might have proved fatal. J feel, and I know that you will ag~ee with me that the saving of even one lIfe makes v.:orthwhile all the time and trouble spent in training. Our training is not confined to first aid and nursing but includes instruction in welfare work, where such matters as knowledge of the services which are available, and the right approach to the patient, are of great importance. I saw examples of the value of such training on my recent visit to Germany. There I met Red Cross officers of the St. John and Red Cross Service Hos~it?ls Welfare Department, at the new JOInt headquarters and at three R.A.F. hospitals. As always, I was mo t impressed with their air of cheerful efficiency. And now I would like to thank you all, whatever the position you hold !n the Society, for all that you are domg so unselfishly. I know well what thiS means to you in time and resources.'

FIR ST AID & NUR SING, MAY/JUNE 1955

BRITISH ELECTRICITY AMBULANCE CENTRE National First Aid Competitions SPA.RKS! Yes, and bright sparks too, In the gUise of 22 teams, ] 3 men and 9 women, of first aiders who had been the winners in their respective Regional Competitions, and were competing in the Finals for the Challenge Trophies presented by the St. John Ambulance Association under whose auspices the Competition~ were held in the Porchester Halls London Both men and women had to su'bmit to ~ team tes~ and pairs (individual) practical tests, which were all of a most interesting character. In the men's team test which was set and judged by Dr. G. M. Shaw Smith, of London, the team find a man pinned beneath a heavy packing case on the bend of a staircase. His mate is on the stair above, but cannot get down to render assistance until the case has been removed. The injuries prove to be a cut on the head fractured right arm at elbow (bendable): fractured Abula (lower end), bruise on ~bdomen, and after ] a minutes signs of mternal haemorrhage. Nos. I and 3 are called to a man who has fallen from a pair of steps on to his hands. Injuries: Dislocation of both elbows and shock. N,os. 2 and 4 find a man on the pavement. He IS unconscious and his breath smells of alcoh.ol. Injuries: Compression and wound on rIght Side of head. These two tests were set and judged by Dr. R. J. Sprenger of Bramcote, Nottingham. ' Dr. R1!pert H. Kipping, of Beaconsfield, set. and Judged the .women's team test, in whIch the competitors are attending a County Show, and are called to attend a man who has been knocked down by the fall of a heavy tail-board at the back of a cattle. transport lorry. The patient, who is conscIOUS for the Arst two minutes is found to be suffering from nerve sh~ck a. compound fracture of left scapula and slmple fracture of left Abula, ff correctly treated he wtll regain consciousness after 10 mmutes.

In the women's dual practical tests the first~ for Nos. 1 and 3, a baby in convulslOns, appeared somewhat simple, but was complicated after 4 minutes by the mother . knoc~ing <;)Ver a bottle of pure ammOnIa, which spills over her right hand. Nos. 2 and 4 find a man lying near an overturned cy:cle, wh?se injuries prove to be conCUSSIOn, bru ise on right temple and fracture of left patell a. These were set and judged by Dr. E. J. Selby, of London. At 4 o'clock Mr. Horace F. Parshall, T.D., M .A.(Oxon.), took his place on the p!atform behind a table upon which was dIsplayed the magnificent trophies and plaques which had been competed for, and he was supported by J. Eccles, Esq ., e.B.E., ~.M . , B ..S~ . , Deputy Chairman (OperatIOns), BrItish Electricity Authority, Mrs. Stew~rt-R oberts, Dr. Smith, Principa l Medical Officer of B.E.A. and the judges. J n. welcoming Mr. Eccles, the Chairman sa.ld. that he regretted the absence of Lord C1tnne, who had been unavoidably prevented from attending. He went on to say that there were many to whom thanks were ~ue, but he w0l!ld like especially to mentIOn The AssocIated British Picture Corpora~ion Ltd. who had again so kindly prOVided and set up the scenery and propsIncludlllg that staircase which had proved so full of peri l ! He was glad that it had now been removed! The stewards and , pa~ients' had also rendered valuable serVlce once more. They were also most grateful to the judges who dev~te so'much of their valuable t~e and skill to raising the stan~ard of effiCiency III the rendering of first aid to the injured. He also referred to the untiring competition secretary Mr. Ge.orge Craft, as well as the branch secretanes and team trainers. Mr. Parshall said that much of the value ?f these competitions lay in what the Judges were able to tell us afterwards, and

D.T/:.f ;VI('~ers of the competition for men's tea ms were the Eastern les trC h ft. YarMrmouth), and here the ca ptain, H. Kerrison. receives th op y rom . J. Eccles.

he invited D r. Shaw Smith to make the first comments. Dr. Shaw Smith, speaking for both himself an~ D r. Kipping, who had judged the women s team test, expressed the very ~reat p leasure they had both experienced Jll coming there that day. They had some strong criticisms .to offer, but they hoped that the competitors would realize that ~hey were in tended to be constructive an d Illtended to help. In the case of the man who had fallen from the steps, more use should hav:e been made of the fact that he was ~onsclous and could have answered qu.estlOns. In the compression case the hot skm an~ slow pulse were diagnostic. I n the men s test not enough had been done as a team. A preliminary examination was all t~at was required on the stairs, the remamder of the treatment being left until after the removal of the heavy case. The teaf!l would have had a much better opportun.lty of carrying out treatment after the patient had been removed from the stairs , Incident.ally, I've.learned to-day more way~ of removing a patient from a staircase than I ever knew before!' he concluded. He congratul~ted all and hoped they would come agam next year. Dr. Kipping, speaking for both himself and Dr. Selby, said that they were agreed that the whole of the work had been good althoug.h they. had to admit that som~ cO~1petltors did not thoroughly know their book. The 'collar and cuff' sling needed practice, for they had noted that som.e ~ade two or three attempts before gettmg It correct. Tn sending messages try to sh?w consideration for others, and when pho~mg for a doctor give as much informatIOn as ~ossible in order that he may form some Idea as to what to bring with him. Also when phoning for ambulance state sex of patient so that a female atten~ dant. may accompany it if necessary. In treatmg . baby for convulsions hold it by the shoulders, and make sure that its mouth IS kept above water. They, like the

W inne~s of .the Women's National Award were Swindon. H ere the ca pta m M ISS R. Taylor receives the award from Mr. J. Eccles .

FIR ST AID & NURSING, MAY/JUNE 1955 other judges, had thoroughly enjoyed their tasks. The results of the competitions were then announced by Mr. Craft, and were as follows : (Maximum marks obtainable 400) ~en

Great Yarmouth .. , ... (winning the Challenge Trophy) 2. Northwich 3. Worthing 4. Stourport 5. Fulham... 6. Kettering 7. Barton... 8. Lyndhurst 9. Pool 10. Kirkstall II. Newcastle-upon-Tyne 12. Tir John l3. Clydes Mill 1.

Marks 297 296 290 277 276 237 227 223 211 199 198 192

165

Women Marks 1. Swindon... ... ... ... 316~ (winning the Challenge Trophy) 284} 2. Kingston-upon-Thames 27U 3. Gloucester ... .. . 260~ 4. Milton Hall and Cambridge 25n 5. Kettering 25Bt 6. Blackburn 253~ 7. Sheffield ... 252 8. Newcastle-upon-Tyne 228~ 9. Bristol Mr. Eccles, before presenting the trophies to the winning teams, was in humorous vein. He said that his daughter was a very keen first aid student, but was very disappointed at the fact that none of the family had yet broken an arm or a leg in order that she might exhibit her skill ! He expressed warm appreciation of the good work shown by the competitors that day and congratulated the winners upon

their successes. He also, however, congratulated the losers, for, he said, if there were no losers there could be no winners and, after all, if they had not been th~ winners in their respective Regional Competitions they would not have been there at all that day. They must bear in mind the donkey work done by all, from the team captains to the reserves, who, he said, were there hoping that one of the competitors would become a casualty in order that the reserve might take his or her place! He reminded them that this was not the end, and that they must not put their books away. The wi.nners would be going forward to the competitions for the Grand Prior's Trophies. He concluded by re~ndin~ his hearers of the voluntary SPlflt whIch was behind the whole movement, and he hoped that they would all go back to spread this gospel amongst those who were not yet members.

Metropolitan Women P olice First Aid Competition Finals EIGHT teams, winners and runners-up in their respective District eliminating competitions, competed at the Percy Laurie House Hall, Putney, for the Lady Abbiss Bowl, the blue riband of the Metropolitan Women Police First Aid tests. The growing interest in first aid by this fine body of women was evidenced by the large number of their colleagues who had assembled to watch the tests, and the comments of the spectators were certain proof that this interest was by no means superficial. 1t was, also, very encouraging to note the support given by the principal officers of the Force, not only of the women, but of the men's Force also. Amongst others were to be seen Miss E. e. Bather, O.B.E. (Chief Superintendent, Metropolitan Women Police), Commissioner G. J. Payne, Assistant Commissioner Capt. Rymer Jones, O.B.E., M.e., Deputy Commissioner H. P. Ralph, Supt. Miss Yates (Chairman of the Women's First Aid Committee) and many others. The competition consisted of a team test and tests for each of the two pairs making up the team. In the team test, a thin, elderly man is found lying face downwards, having periodic epileptiform convulsions, due to hyperinsulinism. He bas, also, an incised wound of tbe right wrist with arterial haemorrhage due to broken glass. There is a simple fracture of the neck of the femur and bruising across his forehead . After five minutes he becomes comatose unless given sugar. His wife is having hysterics. The test was set and judged by Staff Officer S. C. Dearmer. In the first pairs test, for Nos. 1 and 2, they see a man, doing tricks on a moving swing in Battersea Park, slip whilst in mid-air. The swing hits him in the back and he falls to the ground. Injuries: Abrasion on forehead with immovable foreign body, complicated fracture of lumbar vertebrae and simple fracture of right tibia.

Nos. 3 and 4 find a man lying by an upturned chair, from which he has obviously fallen in trying to open a stiff window. Injllri es: Fractured base of skull, compression and fracture of left tibia and fibula. Both the dual tests were set and judged by Div. Supt. P . A. Stacey, S.J.A.B . At the presentation ceremony the Chair was occupied by Miss Batber, who expressed her pleasure in seeing so many interested guests, and welcomed Capt. and Mrs. Rymer Jones and other senior officers of the Force. After explaining that each District had been represented by two teams, the Chairman invited Mr. Dearmer, who had judged the team test, to give his comments. Mr. Dearmer, after describing the test, said that only one team had found and administered the sugar within the first five minutes. Up to that time the patient would have been able to swallow, but after the lapse of that time he had developed coma, when nothing could be given by the mouth. Altogether the first a id had been performed very well. Mr. Stacey, who had judged the pairs test, followed, and confirmed. that he, also, had found the work of a hlgh character. The fractured spine, however, could have been handled mo re gently. 'Care is more important than time' he stressed. Tn many cases the fracture had been discovered far too late, but the treatment of the forehead had been well carried out by all. He pointed out that the patient was hefty, and when they found that the first doctor was out on his rounds they should have 'phoned for another instead of trying to move the patient without medical advice. The patient was facing the open window, and he thought that that would have provided a clue to the cause. Treatment of tibia and fibula had been good, and he had little room for criticism. The results were then announced, and were as follows :-

1. 2. 3. 4. 5. 6. 7. 8.

No.4 District" B " (winning the Lady Abbi~~ Bo~ij NO.3 District "A" (each member receiving a silver teapot) No. 1 District" B " (each member receiving a vacuum flask) o. 3 District" B " o. 2 D istrict " B" I Tied No. I District "A" o. 2 District "A" No.4 District "A"

Marks 312 308 307 280 273 268 255

The Chairman then invited Mrs. Rymer Jones to present the awards to the successful teams. Capt. Rymer Jones expressed the pleasure which he and Mrs. Rymer Jones had experienced in accepting the invitation to attend that day, and congratulated the women's teams upon the rapid progress they had made in so short a time. Supt. Horsley, the competition secretary, also said that their success had been most gratifying. Miss Bather said that there were so many to whom they would like to say , Thank you,' but it was only possible for her to mention a few. First of all they were most grateful to the judges for the time and trouble they had spent in this thankless task. Much of the success of the event was due to Supt. Horsley, who was the mainstay, and had been responsible for all the preparations. Stewards, 'patients,' timekeepers-for the most part always the same faces-all had done their hare, and the teams themselves must not be overlooked. She thanked Supt. Miss Yates and her Committee for their share in the arrangements, reminding her audience that most of the funds had come from the square dances organised by them. Lastly she thanked the Chief Superintendent and officers of this beautiful Section House for having so kindly placed it at their service.

FIRST AID & NURSING, MAY/JUNE 1955

• From a seat In th e audience S ome random (and provocative) comments on the competitions

LONDON TRANSPORT AMBULANfJE fJENTRE First Aid Finals IT was interesting to learn that this had been a record year for this event, for 66 t~am~ had taken part in the preliminary ellmmatmg tests from which the survivors were competing in these Finals for the Challenge and Probyn Shields at the Borough Polytechnic on Thursday 14th April. These consisted of nine teams including one of women, each being set ~ team test, a pairs practical test an individual practical test for two m~mbers of a team and an oral test for each member of the team. . In t~e team test the team, upon approachmg a bus stop, find a man who has fallen from a ladder whilst fixing a notice board. He is unconscious and is found to be suffering from bruising and swelling of the left mastoi.d bone, severe gash on left calf ~Ith artenal bleeding, and a fracture of nght arm near elbow. A passing cyclist h~d covered the wound on the calf with a dIrty handkerchief .and gone for help. He returned some mmutes after the arrival of the team. In the pairs test Nos. I and 4 also find a ~an . who has fallen from a ladder. His InjUrIes prove to be a foreign body embedded in the eyeball, a double fracture of both legs, the left being compound. Nos. 2 and 3 were required to describe and demonstrate the subclavian and femoral pressure points respectively in the mdlvldual tests. .Th~ judges were Dr. D. D. Towle, Dlstnct Staff Officer, No. 1 (Prince of Wales') Distri~t,. S.l.A.B . . (team test); Drs. J. S. BinnIng, ReglOnal Medical Officer, British Railways and F. H. Taylor O.B.E., ~ivisional Surg~on, No. 99 (Lam~ beth) Dlvlslon, S.J.A.B. (individual and oral tests). At the presentation ceremony the Chair was taken by Mr. Alex. J. Webb, General Supermtendent (Staff and Training) Railways, who ~as supported by Mr. A. A. M. Dur~ant, ChIef Mechanical Engineer (Road Servlces), and .Mrs. Durrant, Mr. T. T. She~hard, Rollmg Stock Engineer (Road SerVIces), Dr. L. G. Norman, Chief Medlcal Officer and a Vice-President of the Centre, and the judges. . Aft~r the Chairman's opening remarks m whIch he extended a cordial welcome t~ all those present, and also thanked all those who had contributed to the SLlccess of the event, the results of the competitions were announced as follows :_ (MaXimum marks possible 600) I Ch· ICk . Marks . .1Sw. ... 487·;l (wmmng the Challeng~· Shield 2 for seniors)

Baker Street (women) ... 440~Charlton... ... 432~(winning the Probyn Shield for juniors) 4. New Cross "A" 403t 5. Lots Road 397t 6. Dorking 396 7. Romford' 'A" 346 8. Manor House 345 9. Upton Park "A" 263~ The comments of the judges are alway; welcomed as valuable contributions to the st'-.ldy of text-books and, although short, in this c~se prove~ no exception. Dr. Taylor, speakIng for hlffiself and Dr. Binning, led the way. He believed that the tests had been quite satisfactory, but he admitted that they ?ad tried to catch the competitors out on tune. In some teams the No. ] ~ad spe.nt too much time in giving detailed mstr~ctlOns .and had not given as much practical assIstance as he might have done. Further, bystanders would have been prepared to help if. asked. They made no apology for selectmg the sub-c1avian and femoral pressure points as tests, and had noted that the treatment of the femoral had, as a rule, been more effective than that of the sub-clavian. In dealing with frac~ures t~ere '7'as. a tendency to confuse complIcated wlth' compound.' He concluded by expressing the pleasure which they had both experienced in conducting the tests that day .

2. 3.

Dr. Towle followed, and admitted that ~he team test had been a difficult one, but It was based upon an actual incident which had occurred at a little place in Cornwall when he happened to pass in his car. It had been made more ·difficult by removing all the usual aids like t~lephone, passers-by, etc. As to the test ltself, he emphasized that. they should find out as soon as pOSSIble what had ~appened. Many had been baffled by the dlrty handkerchief they found already on the wounded calf. This sh~uld haye been removed in order to form a dla~nosls. 'You c~nn,ot examine through a dIrty handkerchLef emphasized the doctor. . Taking the pulse must not be a ge~ture, It must be counted. It is the simple thmgs that count. Some examined the eyes thoroughly, others not so thoroughly. Both eyes must be opened in order to compare pupils. Watch for the development of compression, and tell the judge wh~n you ~ave noticed it. As soon as the patIent be.gInS t? come to, talk to him, for he wLll be In a fnghtened condition and need reassurance. He. did ~ot know why all teams were late m gettIng the patient into the ambulance. On the whole however the first aid was good, <\.nd he repeated that

he had included the catches on purpose in order to make the test more difficult. Mr. Shep~ard was .the next speaker, and, after thankrng the Judges who he said although hard-worked men, w~re alway~ ready to answer the call to assist the movement~ he invited Mr. Durrant, whom he descnbed as the 'Father of London Transport,' to present the trophies. .Mr. Durrant, in accepting the invitation, saId that he had experienced much pleasure when asked to perform this pleasant duty for he had the highest regard for those wh~ mterested themselves in the study of first aid. It was one of the finest forms of personal service, and, therefore, he was always pleased to do all he could to help. From what he had seen that day, and from what he had been told, it was obvious that the work had been of an extremely high character. He had been struck by the contrast between the competitions of to-day and thos~ of a. quarter-of-a-century ago, and especLally WIth the realism of the tests ~o-day. Realism lent a much greater lllte~e~t, both to the onlookers and to the partlclpants. It was well worth spending tIme and money on the production of rea.1i~m, for it was a great advantage to trammg. He congratulated the winners and also. the runners-up, and had much pleasure m presenting the awards. Dr. Norman then proposed a vote of thanks to Mr. Durr~nt for not only coming to present the pnzes but for bringing Mrs. Durrant with him. Mr. Durrant had always shown the greatest interest in ambulance work, and they were all most grateful to him for his support. He confirmed Mr. Durrant's remarks respecting the value of realism and thanked the' backroom boys' of the Casualties Union. He had been particularly interested to learn from Dr. Towle that the team test had been based upon an actual incident. Replying to the vote of thanks, Mr. Durrant thanked Dr. Norman for his expressions of appreciation. He felt, however, that their thanks that day were due to Mr. Harden, the secretary, who had worked and schemed so hard to make the event a success. Mr. S. W. Harden, the Centre Secretary thanked the teams for their response to hi~ appeals for increased entries and paid trIbute ~o the work done by the District sec~etarIes. and the many helpers who had assl.s~ed wlth the organization of the competltlOns. He thanked the officers for their sUDPort, the stewards, especially the chief steward, and also the' patients,' especially Messrs. ~uck and Southwick, and conc1ude~ ~Ith an earnest appeal ror more recruIts Into the movement.

B.R.C.S. Finals Was not the bucket a somewhat precarious support? Why so many blankets when room was obviously warm? There was a fire. Pulse should be taken for at least a half-minute and respiration for another half-minute. The stretcher work was good. Palms down in tucking in, please, nurses. Bedmaking was excellent, but some fumbled over enveloped corners. , Discrimination '-the incised wound was more important than the sprain. Does it take three nurses to make a bed? That kettle again! We saw many hands over instead of under the handle. (See , Answer to Correspondent '). I am afraid the rheumatism case caught many chills. Why was one nurse left to make the bed alone? How many forgot the windows? Team leadership (women) might have been better. Don't throw the pillow. It is a thousand to one it will not fall exactly in the required position. One competitor stepped over the stretcher three times. You were distinctly told it was a hot day. Why blankets ? How that poor devil must have perspired ! A distressed patient cannot always locate the exact position of pain. There is, also, such a thing as ' referred' pain. Ask your lecturer to explain this. Triangulars should be folded more neatly, otherwise neat bandaging is impossible. Leave the scene tidy. Collect up bandages, packages, paper, etc. You will receive marks for this. Insufficient care was exercised in turning the pelvis case. Hot-water bottles are not always necessary. Don't let this become a fetish. What is the use of spreading a triangular if material is allowed to spill over the sides onto the ground? Don't fan for five seconds and then leave off. Do it properly or not at all. Direct where the stretcher is required. Don't leave it to the caprice of the bearers. We did not know that there were so many different methods of blanketing stretcher I Bedside manner was not all that might have been desired. We would like to have seen a little more talking to patient. One nurse gave the patient a book to read. The sanitary pail was not always covered. Address more questions to the' patients.' They are well trained. Nurses should be more familiar with the measuring glass. Observation must be cultivated. How many passing backwards and forwards noticed the patient leaning out of bed? Tt was a good test. What a long time those ring pads took to make. Study the comfort of the patient when administering an inhaler. Some forgot to raise the foot of the bed. Don't put that cork down-it might get lost, or, at least, dirty.

British Electricity Too much equipment provided. We would like to see more improvisation. Many things are asked for which are not required. Hot-water bottles are often already covered. Leave this for the competitors to do. Was it the Epsom salts which caused the sudden recovery ? Of what use are empty hot-water bottles? Cups and saucers left on the floor! There was a table to put them on. You can't take p. and r. without a watch. One team of nurses skipped on to the stage like a troupe of ballet dancers. Why not question the patient? He was conscious. Firms should provide their teams with shorter overalls. The long ones hindered operations. There is often a tendency to confuse , scapula' with' clavicle.' Don't fumble in making a clove-hitch . Learn to do it smartly. What odd things are to be seen on stalls at county shows! Many overlooked the fact that NERVE shock was specially mentioned. Stretcher work by women was excellent. Four women lifting. Why not ask the man to help ? 1t was obvious who were used to handling a baby and who were not. Two teams moved the patient before immobilizing the knee. It is of no use raising head and shoulders after knee has been splinted. Which is the correct position for knotside or middle of sale? Who took the blankets off, and why? Surely the hot-water bottles did not require re-filling within five minutes! Who placed the small box on tbe stairs? Text-book says 'Remove cause' not , Create a new danger.' 'Your ambulance bas arrived' often creates consternation. Don't supply filled hot-water bottles. Let the team do it. Opening and preparing stretcher is a two-man drill. , He can talk' said the judge, but the hint was not heeded. 'I see no obvious wound '-but there was! Examine carefully. Diagnosis was weak on the whole. Sure, I guess that tea was certainly sweet! , Give him a cigarette '-why not give him one of your own? Age of patient? Often an important factor overlooked. 'Where's the nearest· telephone?' It was right in front of him .. Technique of pulse-takIllg needs attention. One team had four captains giving orders simultaneously. How often the tea is left to get cold. You cannot treat before you have diagnosed. It does not require two to take p. and r. When she tossed the hot-water bottles, did she hope they would fall into the required_position?

London Transport Don't lean or step across your patient. Handling of dressings was not as careful as it might have been. Several times material was seen on the ground. How often support of the head is overlooked. Digital pressure must be applied immediately. There is often unnecessary delay. A blanket or jacket thrown carelessly over a patient is not' covering' him. 'Examine for other injuries.' This is often forgotten. Some teams have developed the habit of raising one end of the stretcher to test it. Why? We noted that one team protected the blankets with sheets of paper. There is a correct technique for administering fluid to a supine patient. It took one nurse exactly five seconds to take the pulse! Too many questions-not enough physical examination. How many remembered that the weather was' cold and showery' ? Do one thing at a time-and complete it. One member tried to open , prepare and blanket stretcher all by himself. The efficiency of one member of a women's team was outstanding. We understand that she was a welfare officer. There was no cold water for a cold compress. Only one thought to use rainwater-it bad been raining. Why continue to control traffic after patient has been removed to shelter? Few reached the 'load ambulance' stage. Was the test ill-timed? Which is of first importance, diagnosis or sending for doctor and ambulance. Those fractures might have been handled more gently. No dressing will 'stay put' unless bandaged. Few enquired the state of the weatheroften an important factor. Oh! Those cups and saucers left on the ground! Why waste time on the cyclist? There was nothing the matter with him. When will competitors learn the correct method of testing stretcher? Too many' grannies.' Why park that pile of blankets on the poor devil's chest? Congratulations to the team who opened, prepared and blanketed stretcher inside the ambulance to keep it dry. Metropolitan Women Police Wife supplied too much information which should have been' fished· for. Insulin overdose and diabetic coma often confused. Lecturers shou Id spend a little more time upon this. Search for signs of H.T. superAuous once cause established. , Is your wife quite happy? ' That femur took a long time to diagnose in many cases. A wet dressing is not a cold compress. Serious discussion: 'Long splint or not? ' Hot-water bottles were often an afterthought.

F IRST AID & NU RSI G, MAY,J U E ]955

FIRST AI D & NUR SING, MAY/JUNE 1955

New Type of Aluminium Stretcher THE regular and conventional type of canvas-bed stretcher has been superseded by a newall-metal type designed and patented by O. T. (' Doc') Smith, First Aid Officer in charge of N.Z. Forest Products' casualty rooms at Kinlcith. The new stretcher is made throughout of aluminium alloy, is exceptionally strong, and weighs only 20 lb. It is non-rusting and can be stored outdoors without harm. The design consists of a one-piece openmesh wire bed 6 ft. 3 in. x 1 ft. 9 in. attached to a tubular aluminium frame. The bed, with nve transverse bracers beneath the one-piece open-mesh wire is tensioned to provide correct support for all classes of accident cases. For instance, the old type canvas stretchers require that in cases of spi nal injuries the entire bed be stiffened by the use of . fracture boards.' This procedure is unnecessary with Mr. Smith's stretcher because the taut wire bed gives safe support without any additional equipment. There is no specific' head' or , ~ail,' therefore a patient may be placed either way on the stretcher. A special feature is the carrying rail. which is supported 2i in. above the bed and is built around the stretcher. The rail can be grasped at any point along the sides or ends by any number of helpers, and is a boon when transporting a casualty over l<;>ng distances or in rough country, partIcularly on steep gradients.

T he new stretcher in actien

Sace-a-life "Teel.'

Stroud: Particulars from C. L. Hill, Newbrook, Queens Road, Stonehouse,

THE appalling loss of life through drowning which takes place annually around our coasts during the holiday season has been given much serious thought ~y the St. Joh~ Ambulance Brigade, and ~t had b~en decided to tackle the problem In a senes of ' Save-a-Life' weeks when the public will be instructed by members of t~e Brigade. in the art of Artificial RespiratIOn. The maugural meeting to launch the scheme was held in the Chapter Hall St. John's Gate on 21st May, and wa~ presided over by Lt.-General Sir Otto Lund, K.e.B., D.S.O., Commissioner-inChief, who was supported by Mrs. Grosvenor, e.B.E., Deputy Superintendent-in-Chief Maj. A. e. White Knox, O.B.E., M.e.: M.B., Ch.B., Surgeon-in-Chief, Mr. Horace F. Parshall , T.D., M.A.(Oxon), DirectorGeneral of the St. John Ambulance Association, Col. G. W. M. Grover, O.B.E., R.M.(Retd.), General Secretary of the Royal Humane Society and Lt. Genera I Sir Henry Pownall, K.CB. , K.B.E., D.S.O., M .C, Chanceller of the Order of St. John.

CasI,alties (;~"ion Buxton Trophy- Eliminating Round ] 26 teams have entered for this year's cont~st ~nd it has become necessary to run e!tml~attng rounds in J 6 regions. A team entenng from Dublin has been granted a bye to the final. 15 contests will take place on Su.nday 10th July at 2 p.m. at the follOWing places :Truro: The County School for Girls Treyew Road, Truro. ' Wi.nchesrer: ~eeke Manor, Winchester. Brtghron: Bnghton ColJeQ:e. Dorking: 'Deepdene,' D~rking.

Glos.

Reading: Brocks Barracks Playing Field Oxford Road, Reading. ' Slough: Particulars from P. L. Pendry 39 William Street, Slough, Bucks. ' Putney: Putney Common, Putney Hospital. Southelld-on-Sea: Priory Park, Victoria Avenue, Southend. Birmingham: Kynoch Works Sports Ground, Perry Barr, Birmingham 6. Norwich: Junior School, S1. Williams Way Thorpe, Norwich. ' A Itrincham : Altrincham Association Football Ground, Moss Lane, AItrincham. Hull: Particulars from W. Bromfield 23 Aberdeen Street, Hull. ' Darlington: Darlington Railway Athletic Association, Rugby Football Field Brinkburn Road, Darlington. ' Newcasrle-upon-Tyne: Royal Grammar School, Newcastle-upon-Tyne. The ]6th contest will be held in Glasgow on Sunday 4th September. Spectators will be welcomed at all these events . The contest consists of a realisti cally staged team test and a diagnosis test lDvolvtng the examination of a series or , casualties.' Stanley Shield The Union. again provided' patients' for many preliminary rounds and also fo r the team tests in the Finals. . We regret that pressure on space in this

I ~sue, due to the large number of competi-

tIon finals, prevents th e publication of a full report of many events. Further competitions WI ll be reported in our next issue.

The Repair

A second feature is the full length 'sleigh runners' beneath the stretcher. These are special one-piece castings which pass the full depth of the stretcher from the top carrying rai l through to the sleigh runners. The stretcher can sl ide its full length over such obstacles as logs, rail and wire fences, fallen trees, heavy undergrowth, etc., and a patient can be handled with greater safety than formerly on a mountainside, quarry face, mine shaft and up or down steep narrow stairways. It is very simple to strap a patient to the stretcher and, when necessary, the metal framework can be used as splints. Ban dages pass easily under the patient because he is not lying in a hollowed bed but on a tensioned frame. R opes can be tied to the top carrying rail to restrain the stretcher when used on an extra steep gradient. When transporting over long distances a blanket is placed on the mesh bed for additiona l comfort an d warmth during shock. Three doctors who have been associated with the type of accidents common to all bush and milling operations and the diffi culties. of safe transport over rough country, have lDspected and tested the stretcher. Each gave as their opinion that it was a marked advance on other types and especially ideal for the outdoor purposes for which it was designed .

Squad When you receiYe a wound or a burn, your body mobilizes its repair

squad in its work and may even o\'er\\'helm it, that the wound heal

slowly or not at all.

0 0

infection must be prevented or suppre sed, and this some of the older antiseptics do quite effecti\ ely. But no antiseptic, howeyer efficient, \\-ill heJ.I a wound; only the repair squad can do that. The drawback of the older anti eptic,

L1ch as (lcri-

flavine, tincture of iodine, propam idine, etc., is that they interfere \\ ith the repair squad \ (lcti\ ities _ and thus themselYe slow down the proces of healing .

St. George Ambulance & Nursing Corps The St. George Ambulance & Nursing Corps states there is considerable progress taking place in the development of the organisation. The following new units have recently been established by t his Corps : Londl?l1 area: Clapham, Walworth, Bow, Chmgford, Barking. Eastern area: Chelmsford (North an d Sou.th), Collier R ow, R omford, Til b ury, White Notley. South Eastern area: Faversham, Seve noaks, North Berstead. Midland area: Leicester Melton Mowbray Nuneaton, Dudley. ' , North Western area: Leek. Yorkshire area: Sheffield, CrossAats, Cottingley, Barnsley. A new road post has been opened at Ba nstead, and a further beach h ut at Canvey [sland whilst a further twe nty new centres are p lanned for the next mo nth. The Cadet Shield Final was reached by thr~e teams representing the following UnIts: Canvey, Cheam, and Miton R egis, and the final contest was held at the Lycett Hall, Mi le E nd, o n Saturday, 14th M ay. D r. S. So lomo ns of the Lo ndo n Jewish H ospita l was the judge a nd the Corps Chief Co mmandan t attended. Canvey Is land took the Shi eld h o me wit h J 88 m a rks the run ners-u p being C heam (Sur rey) with J 61. To a id further develop ment, orga nizing officers have been ap po in ted for the fol lowing areas: South ; Midla nds a nd Wales; North E ngla nd and Sco tla nd . A n e ntirely new departure is the effor t to sell direct to th e p ublic C011l:11o n sense h ome first-a id kits.

quad to make good the

damage. Infection by bacteria hinders the rep.:1ir

, Furacin " howeyer, i an entirely ne\v type of aermicide which de tro)'s bacteria a.nd l)reYents b

infection outstandingly w ell, and yet lea\ es the repair squad unharmed to get on \\ith healing the wound. For thi

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••••••••••••••••••••

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FIRST AID & NURSING, MAY/JUNE 1955

* First-Aider~s Crossword No. 1 ? Compiled by w. A. Potter

Beade,.s~

Queries Answered by Dr. A. D. Belilios A. E. (Risca) writes :Please 1V0uld you be kind enough to give me an anslVer for a dual injury, a fracture of the lower jaw (both sides) no other face, head or upper limb injuries, and a fractured pelvis. The 'black book' states you transport patient face down in cases of fractured 100ver jaw (both sides) with the head resting on a 'T' bandage tied on to the handles of the stretcher, with a pad on the chest to throw head forward. Fractured pelvis you transport on the back with 10IVer limbs bent slightly and supported on a blanket if patient desirous, and four , T' bandages applied. What would be your treatment for a patient suffering )vith both injuries? Answer

ACROSS 1. His blood is group' 0 ' (9,5) 8. Compel... (7) 10. On the head of a girl , but quite the reverse on the animal (7) 11. Describes disease very seldom seen (4) (5) 12. Bath-not hot, not cold (4) 13. May slip intervertebrally 16. Female sex hormone makes gent sore (8) 17. Inflicted by insects and plants (6) (6) 19. Grub little Margaret obtained 21. Disturbance of normal bodily '" .. . '" (8) function 24. Muscular tension (4) 25. A poem used in medical electricity (5) (4) 26. Neat eruptor ' " (7) 29. Fruit for the ruler's lady 30. 11 down usually is (7) 32. Knee-jerk (8,6)

DOWN 1. Employ or employment 2. Necrotic tissue resulting from blockage o f an artery 3. Anatomical borrowing of Mark Anthony 4. Fatty 5. Drunken revel... 6. Common cyst has a melody 7. Indicatcd by positive Benedict's reaction 9. Visual organ on hire for a small hole '" ... ... ] 1. Disease from which Emma is hurt ] 4. Nerve for travel! ing ? 15. Excretory seat ? ... 18. Afraid to start a watch 20. Nerve networks ... ... 22. Conscientious and respectful... 23. Doctor available jf required . .. 27. The nurse should think of her patient as more than this 28. Troublesome injury by dog, frost, or gnat ... .. 3J. Loose beginning of purgative

(3) (7) (4) (6) (4) (7) (10) (6)

(10) (5) (5) (4,2) (7) (7) (2,4) (4) (4) (3)

SOLUTION TO CROSSWORD No. 16 ACROSS DOWN 1, Electric; 6, error' 10, kaolin 2, Loosens; 3, chin; 4, represent; poultices; 11, lief ; 12,' Metacarpal; 5, crura; 6, extraction; 7, recipes; 14, spore; 15, batiste; 17 neatest . 8, resolves; 9, skull; 13, sobersides' 19, clove; 22, industrial' ' 24 salt ~ 15, bucc~neer; 16, incision; 18, abdomen; 26, immediate action' 27 ' nine~' 28' 20, elation ; 21, stone; 23, rears; 25, "" surgeons. ache.

The answer depends on the relative severity of the injuries and the complications present. In many cases, it will suffice to transport as for a fractured pelvis but with the head turned towards the less injured side of the jaw and the first-aider maintaining continuous observation on the breathing and colour. Any sign of threatened asphyxia calls for immediate pulling forwards of the tongue by grasping it with the aid of a clean piece of material.

FIRST AID & NURSING, MAY /JUNE 1955

Transvasin brings the esters of NICOTINIC ACID SALICYLIC ACID p-AMINOBENZOIC ACID

to the focal point of soft-tissue rheumatism ./

The esters in Transvasin, a new preparation develope~ by H~ol S.A., our ~wiss ~sso~lates, rea~y

,/!!t 1Pqr" ' ~y!':....... .. . . . p~ss the skin barner III therapeu.tIc

, .:' quantities and enable an effectIve .. concentration of the drugs to be . .' .. built up where they are needed. Transvasin not only induces vasodilation of the skin with a superficial erythema, but also brings . about .a .deep hyperaemia of the underlying tissue~. It 1S .non-Irnt~nt, and can be safely used on delicate SkIllS. It 1S now b~lllg widely prescribed, with successful clinical results: Sl.nce a very small quantity is sufficient for each applicatIon, the cost of treatment is extremely low.

T. H. H. (Newark) writes :In treatment of' Concussion' (page 170, sub-heading 2 Shock, H.F.A.B.) we are advised to keep the patient lying flat with head turned to one side. May I respectfully ask if we are treating/or' Concussion' or 'Shock'? Shock, I appreciate, is present in every case of head injury, but you will appreciate Sir, that this treatment is opposite to the treatment advised in the St. J.A.A. manual? Would you please explain the reason for the treatment given in your book, I understand that the treatment in the St.J.A.A. manual is aimed at preventing or minimizing the effects of , Compression' ?

Salicylic acid tetrahydrofurfw y I-ester I 4 ° Nicotinic acid elhy l-ester 2 ° '0 N icotinic acid ll-hexyl- ester 2 o~ 2°'10 p-A11Iillobellzoic acid ethy l-ester Water-miscible cream base ad 100 % 01

. ,is av al'lable in I oz. tubes, price 4/-. It is. not b Transvasm . d to the. public . Samples and litera ture wlll e ad vertlse g ladly se nt on reque st .

LONDON, S.W.I. WHITEHALL 8654/5/6 11 WATERLOO PLACE, LLOYD-HAMOL LTD., Transvasin d d -k of Lloyd-Hamal Ltd. is the registel'e tra e mar

FlRST AID & NURSING, MAY/JUNE 1955

Answer

Your question is an example of paragraph 4 on page 17 of the S.J.A.A. manual which recognizes the fact that there may be two schools of thought in any first aid problem and that both may be right. Keeping the patient flat as advised as an immediate treatment in the Handbook of First Aid and Bandaging is based on the presence of shock but assumes careful observation on the part of the first-aider. It is generally not possible at this stage to spot compression. The slightest sign of the latter calls for raising of the head and shoulders. I agree that the treatment advised in the S.J.A.A. manual is aimed at preventing or minimizing the effects of compression and is based on the principle of giving priority to the more serious suspected injury.

J. C. (Jersey) writes :A fellow worker has wagered me a £1 to a 1/- that hair has blood in it and can bleed when cut and that there is no blood supply to the eyelids. I have tried to convince him otherwise, but he says he never bets unless he is quite certain.

I think you can fairly collect your £1, but of course, the roots of the hairs from which they grow have to possess a blood supply and if this is interfered with, growth ceases and baldness results. There is, of course, a blood supply to the eye-lids. They will bleed if cut.

Answer (1) War-time experience showed

that some of the procedures in the old book could be simplified and that greater attention had to be paid to shock. Moreover, the new book

Miscellaneous Advertisements Advertisements with

G. G. (South Shields) writes :As a comparative newcomer to First Aid I am quite confused about one or two items, and I hope y ou will oblige by enlightening me. :(1) I am in an SJ.A. Brigade and I am constantly in opposition with the chaps who learnt first aid /rom the , old Book' so would you kindly let us know how the new ideas were evolved, why and do they supersede the' old Book' ? (2) Why can't 1 apply artificial respiration to a patient who is not breathing because of the effects of blast?

remittance should

be sent to

Rate 4d. per word, minimum 65.

Box numbers h. extra.

J.A.B. Car Badges, 30s. S.J.A.B. Badge Wall Shields 26s. 6d. S.J.A.B. Gold cased crested CuffLinks, 42s. S.J.A.B. Badge Ladies' Brooches, ISs. Trophy Shields supplied. White' Old England' shirts,2Is. 6d. ; Poplin quality, 30s. (state collar size). Medal ribbons 9d. each on buckram for sewing on uniforms, Is. each ribbon if mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for leaflets.-Montague Jeffery, Outfitter, St. Giles Street, Northampton.

recognizes alternative treatments advised by first aid authorities besides the S.J.A.A. Nevertheless there are many points in the old book which still remain excellent and time alone will show whether some of them will not be revised. (2) Because the lungs have probably been damaged and may contain numerous haemorrhages which manual methods of artificial respiration would tend to increase.

Assisting THE MOVEMENT In cases where colonic stimulation is indicated, , PETROLAGAR' assists the movement surely but sub tly.

By supplying an unabsorbable emulsion

a comfortable,

Answer

encourages the return of normal habit. Agreeable

An infectious disease caught from sick parrots and occasionally spread from one human being to another. Onset sudden after an incubation period of about ten days. The usual symptoms and signs of fever are present and are often accompanied by a troublesome cough which in some cases is due to pneumonia. In other respects the disease may resemble typhoid fever. The illness lasts from two to three weeks and may be fatal.

FIRST AID TO THE INJURED AND SICK Edited by A. P. GORHAM. M.B .• Ch.B., M.R.C.S. Police Surgeon, City and County of Bristol

that augments the in testinal fluid content, it provides a soft ductile f~cal mass that promotes

take,

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action, and

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, PETROLAGAR' EM

John T;J!y eth & Brother Ltd., Clifton House, Euston Road, N. TV. I

UNIFORMS and LADIES~ GREAT ()OATS & ()OSTUMES

MEN~S

for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

'FIRST AID' WALL DIAGRAMS 26 X 40 in. A-G Anatomy and physiology. H-J The triangular bandage. K, L The roller bandage. M, N Hremorrhage and wounds. 0, P Dislocations and fractures Q, R Transport. S, T Artificial respiration. Single Sheets: Linen - 65. 6d., post 4d. Paper - 35. 6d., post 4d. Set of 20, on Roller; Linen - 1325. 6d., post free. Poper - 665. 6d., post Is. 8d.

SCENT CARDS, 250 17/6, 1,000 52/6. Tickets, Samples free-TrCES, 11 OakPosters, Memos. lands Grove, London, W.12.

S. E. B. (Colchester) writes :Recently I salV in the papers reference to a disease called Parrot Fever. Some il?formation about this ailment p1ease.

Nineteenth Edition. Completely revised. 26 I sc thousand 286 pp., 286 illustrations, some coloured, 65. 6d., post 4d. WARWICK AND TUNSTALL'S

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FIRST AlD & NURSING, MAY/JUNE [955

The British Red Cross Society have specially adopted a set of 6 sheets, A, D, M, N, 0, P, which can be supplied on linen with fitt ings for the special pr ice of 40s. post I s. 3d.

JOHN WRIGHT & SONS lTD., BRISTOL

DOBSON & SONS (London) UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS S.E.1 LONDON BRIDGE 154 - 164 TOOLEY STREET 'Phone:

Hop 2476 (4 lines)

'Grams:

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FIRST AID & NURSING, MAY/JUNE 1955

FIRST AID & NURSING, MAY/JUNE 1955 l(

Tel: CLErkenwell 9274 (S lines)

1955 PRICE

AMBULANCE GEAR

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

LIST

Officers : JACKET .................................... fro111 £7 17 10 in Black Woaded Worsted TROUSERS...... ........................... £3 2 7 Ditto OVERCOAT................ ............... £11 5 7 hl Quality Sheen. Grey Melton RAINCOAT.......................... ...... . " £12 11 8 in Black Wool Gaberdine CAPS............................... ......... .. according to rank Privates : TUNIC (Lay down Collar) ............ from £3 18 3 in Black Tartan, New Pattern

The UP AND DOWN action is quick and easy for loading or unloading. A. Shows the two stretchers in position.

B. Shows the top stretcher lowered ready for loading.

(Lined sleeves 5/6d. extra)

TROUSERS.... . ............ ......... ...... OVERCOAT. .......... ....... .. .. CAPS ........ ... .. ... ...... ... ............. ...........

£2 6 0 £5 18 5 11 9

PATENT

BARNETT MITCHELL L TO.

MITCHELL HOUSE, 228 OLD STREET, LONDON, E.C.2

. .'

·c~ "PORTLAND"

Aid for the Brigade

•

C. lllustrates the same Gear with the top stretcher frame hinged down for use when only one stretcher case is carried. D. Shows the same position as in "C' only with cushions and back rest fitted for convalescent cases.

Ditto in Superfine Grey Cloth Regulation

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

PRICES INCLUSIVE OF PURCHASE TAX

U"iiorn, COlltractors to H.H. 60vernn,ellt Public Bodies~ etc.

Full catalogue of Ambulance Equipment No.7A will be sent on ,~uest.

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STRETCHERS

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Affections of the eye, ear and nos:

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SANOID COLLAPSIBLE STRETCHER S.I473 Well-seasoned hardwood r: o :es . Rot-p roof canvas. Mallea~le iron traverse bars and run~ ers. Complete with Straps. Pn ce 103/ - each Carriage paid Other types available.

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This vehicle is a 4-wheel drive Land Rover which has been modified and equipped as a mobile dispensary. Features include insulated roof, special ventilation, builtin washing faci lities, fresh water supply from Polythene tank, fitted cupboards for drugs, dressing and spl ints. The nearside body interior is fitted with a folding stretcher gear, and additional accommodation is provided by a tent which fastens on the rear of the body when t he doors are open , and t he dispensary is in operation. You are invited to apply for full details of Mobile Medical Units, Ambulances, etc., built to your particular requirements for service in any part of the world.

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JULY/AUGUST 1955

INFECTIONS

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antipeol cu taneo us ointment Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections ; OPHTHALMO-~NTIPE.OLfor .ocular infections; DETENSYL for reduclDg arterial tensIon. ME D I CO-BIO L O GICAL L AB OR ATORIES LTD., C A RGREEN RD.,SOUTH NORWOOD . S.E.25

Printed by H OWARD, JON ES, R OBERTS & L EETE, Ltd ., .26-28 Bury St reet, St . Mary Axe, London, E .C.3, and published b y t h e Pro pnetors. D ALE, R EYNOLDS & CO., L td., at 32 Fmsbury Square, London, E.C.2, to whom all communications should be addressed.

FIRST AID & NURSING, JULY/AUGUST 1955

STRETCHERS

are only one of the hundreds of items of FIRST AID REQUISITES which we manufacture. Established in 1878, and Pioneers of Industrial

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18 FITZROY STREET, FITZROY SQUARE, LONDON, W.1 TELEPHONE: MUSEUM 2073

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DOBSON & SONS (London) UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS 154 - 164 TOOLEY STREET LONDON BRIDGE S.E.1 'Phone:

Hop 2476 (4 lines)

'Grams:

H OW many readers remember the

Nursing This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.C.2, for the purpose of providing an informative technical service on first aid and nursing. We welcome contributions.

industry.

THE HOUSE FOR

Opisthotonos P

& Editor: Peter I. Craddock

provide the most complete medical

First Aid

"Hobson, Sedist, London"

July/August 1955

In this Issue Opisthotonos ?

Forthcoming Events Everyday Emergencies

Women Police Competitions

S.l.A.B. Competition Finals ...

S.l.A.B. Cadets' Finals

N.H.S.R. Finals

B.T.C. Combined Competitions 10 From a Seat in the Audience

Readers' Queries

News and Notes

First-aider's Crossword

no you know that • •• 1. The cardinal signs of inflammation, redness, swelling, heat, pain and loss of function were first recognised by Aurelius Cornelius Celsus, a Roman physician and writer (about 25 A.D.), from which they are sometimes called the Celsian signs ? 2. The internal heat of the body is 10 cC. higher than that of the surface ? 3. The earliest mention of artificial respiration is to be found in the Old Testament, IT Kings 4, verse 34 ? 4. Electric shock from A.C. is far more dangerous than from D.C. ? 5. Pythagorus founded vegetarianism in the 6th century B.C. ? 6. In men there are slighly more erythrocytes (red blood corpuscles) to the cubic millimetre than in women ?

reference in the Sept./Oct. 1954 number to this type of convulsion, in which the back muscles are contracted, causing the arched body to rest upon the head and heels ? The first-aider is taught to look for this condition in strychnine poisoning, but it was pointed out in the ' Do You Know That? ' feature that it is also found in tetanus and a certain type of meningitis. An interesting query touching this point arose at a N.H.S.R. Mobile First Aid Units eliminating competition held at Hellingly, in Sussex. One of the , patients' suddenly had a 'fit,' which at first appeared to be epileptic in character, and indeed, we learned from the judges that this was the intention. In the first test, however, our attention was drawn to the fact that he appeared to be simulating opisthotonos. Could this have been accidental ? Careful watch, however, disclosed that this was repeated in the following six tests, not only by this male , patient' but by a female' patient' in the next ring, suggesting that they had been definitely instructed to adopt this position. Enquiry at the Casualties Union dressing marquee confirmed this. One cannot help wondering if this could have created any doubt in the minds ofthe medical officers in charge of teams, and whose duty it was to diagnose. In these competitions, unlike the first-aid competitions in which diagnosis is carried out by first-aiders, this is the function of the medical officer in

charge of the team. Strychnine poisoning would surely be ruled out at once as being unlikely to be associated with a blitz incident. The incubation period for tetanus is from 4 to 7 days-sometimes as long as ten-so that, as the injury was supposed to have taken place but a short time beforehand, this, also, could hardly be considered. Posterior basic meningitis (almost) alone remains. Here, however, complete opisthotonos is uncommon, and, in any case, does not develop within a period of a few hours. True, when it does occur, it is sometimes preceded by a scream, although this by no means resembles the characteristic prodromal 'cry' of epilepsy. There is, however, still one other possibility. Cases of hysteria have been recorded, although rare, in which tonic rigidity of the abdominal muscles, and some opisthotonos, closely resembling tetanus, have been observed, and possibly this may have been in the mind of one of the competing medical officers who said that he had himself diagnosed it as hysteria. We would certainly welcome comment, especially from the judges of that competition, in terms which could be understood and, therefore, prove interesting to the readers of this journal. It only remains to refer to the faking and acting of the members of the Casualties Union, who had supplied the 'patients.' They were excellent.

Fortllcol"ing Evellts · 9th September: United Kingdom Atomic Energy Aut honty Competition, Aldermaston, Berks, 2 p.m.

ational First Aid

23rd September: Fire Brigades National First Aid Competition, Folkestone, 2 p.m. 2nd October: 4th October : 26th October :

Casualties Union First Aid and Diagnosis Final Competitions, New Gas Works, Ponders End, 2 p.m. Gas Industry National First Aid Competition, Conway Hail, London, W.C.1, 9.30 a.m. General Post Office National First Aid Competition, Porchester Hails, London, W.2, 9.30 a.m.

17th November: Grand Prior's Trophy Competitions, Porchester Halls, London, W.2, 9.30 a.m.

FIRST AID & NURSING, JULY/AUGUST 1955

COUR,S E IN ELEMENTARY FIRST

AID

Everyday Emergencies By A. D. Belilios M.B., B.S. (Lond.), D.P.R. (Eng.) STUDENTS of first aid have to spend a considerable amount of time learning how to deal with the more serious accidents and illnesses such as fractured spine, cerebral haemorrhage, etc., since these conditions call for particular skill and care in their treatment. For this reason, minor ailments and accidents do not receive sufficient attention in many courses of training although when it comes to the actual practice of first aid, they form the bulk of the cases with which the first-aider has to deal. The public are quick to notice how efficiently these minor complaints are treated, and may well base their judgement on the value of the first aid movement as a whole on the competence displayed by a first-aider as he deals with a minor disorder. This is therefore an important article since it describes some of these minor ailments. Stings.-Those caused by wasps and mosquitoes are the most common. A bee often leaves its sting in the skin and this must be removed either by levering it out with the point of a sterilized needle or by the use of sterilized splinter forceps which have very fine points. If the latter are used, the grasp must be made as near to the skin as possible since a bee sting has a little poison sac at its end which if pressed upon causes more poison to be introduced into the wound. Relief from the pain of a sting can be given by bathing with weak ammonia or with a solution of bicarbonate of soda, two teaspoonsful to the pint. An alternative is antistine cream which should be smeared over the skin and renewed at intervals. If swelling follows the sting, cold compresses or an evaporating lotion can be applied. Occasionally severe general symptoms follow a sting particularly that of a bee or a wasp. These serious symp.toms include, amongst others, a choking sensation, an irritating cough, shortness of breath and

wheeziness. There may be generalised itching and nettle rash. The characteristics of shock may be present and death may occur. Patients who show signs of allergic reactions to bee and wasp stings should be warned that their attacks may become worse with subsequent bites. They should, therefore, be advised to do all they can to prevent themselves being stung, e.g., the beekeeper may have to give up his hobby. Doctors can prescribe preventive tablets to be taken immediately by a susceptible subject when he has been stung and, if symptoms arise, medical aid should be obtained since an injection may be necessary. Stings which occur in the mouth may be accompanied by considerable swelling and once again cause difficulty in breathing. The patient should be kept seated and a mouth wash of bicarbonate of soda, two teaspoonsful to the pint used. Hot compresses can be applied to the front of the neck and medical assistance should be obtained as quickly as possible. Foreign body in the ear.-This is not an uncommon accident, children playing with beads, for example, may insert one in the ear. No attempt whatever should be made by the first-aider to remove the foreign body since there is a risk that in so doing he will force it further inwards and injure the drum. The child should be taken to a doctor and in the meantime prevented from touching his ear. He can be given a toy to hold in one hand while the first-aider leads him with the other. The only exception to not removing a foreign body from the ear is in the case of an insect. In this event, the patient can be laid on the unaffected side and the ear filled up with olive oil or surgical spirit. The insect will then float to the surface and can readily be removed. Foreign body up the nose.-This again is not an uncommon accident in children and the object may be quite difficult even for a doctor to

remove. A similar treatment to that recommended for a foreign body in the ear should be adopted and the patient instructed to breathe through his mouth. Medical assistance is essential. Swallowed foreign bodies.-All sorts of objects are occasionally swallowed by children such as coins, small toys, pins, etc. Most small objects pass through the intestinal tract quite naturaIJy and leave the body via the anus. First aid treatment consists largely of 'don'ts.' Thus, no attempt should be made to induce vomiting and the use of castor oil is undesirable since it cause~ agitation of the intestines and thus possible damage through the foreign body being thrown against the delicate lining of the intestine. Fluids should be withheld and stodgy food such as bread, porridge, etc. given. This will have the effect of wrapping round the foreign body and protecting the intestines. Very often it takes up to forty-eight hours for a foreign body to pass through the intestinal tract and if the doctor is in any doubt as to its passage, X-Ray films will be taken. Splinters.-Splinters in or under the skin are very common and require skilful removal. First of all the first-aider must ensure asepsis by washing his hands and sterilizing any instruments which he intends to use. Sometimes a splinter can be coaxed out with the aid of a needle but it is more satisfactory to use splinter forceps. A firm grasp of the splinter is essential or it may easily break off leaving part still embedded under the skin. After successful removal, the skin must be painted with surgical spirit and a small dressing applied. Should the splinter break, during removal and the foreign body remain embedded under the skin, medical attention is essential, and the same advice applied to any other embedded foreign body such as a broken needle, etc. While awaiting medical services and particularly if the·patient

FIRST AID & NURSING, JULY/AUGUST 1955

has to be moved, a light temporary dressing should be applied to the wound and the affected part splinted since involuntary movements of muscles, etc. may cause the foreign body to become more deeply embedded and thus more difficult for the doctor to remove. A difficult accident to treat is when a splinter becomes embedded under a finger nail. It is far wiser in such a case to leave the treatment entirely to the doctor since attempts by those who are inexperienced to remove the foreign body may cause it to break under the nail, once again making the case much more difficult for the medical attendant. Septic conditions.-The advice of a first-aider is often sought for septic conditions such as boils, whitlows, septic wounds, etc. A boil is a small area of mfiammation occurring in the skin and caused by germs which have entered the minute glands of a hair. Everyone is familiar with the characteristics of a boil, namely a small red, painful tender and swollen area, which ultimately forms pus that leaves the body when the boil bursts.

Metropolitan~

IT was a very great privilege to receive an

invitation to attend the Annual First Aid Competition for the Gracie Lucas Cup arranged by these three Women's Forces (1 wonder if I have placed them in the right order !). The atmosphere was anything but that of a competition, for it was really a semi-private social gathering, attended by most of the principal officers of the three Forces, and the Competition at first seemed almost incidental. However, this proved to be by no means the case. True, there was an entire absence of the usual scenery forming a background to the test, and it was not open to the public. I learned that it is customary for each Force to act as host in turn, and this year it was the turn of the B.T.C. Women Police to act in that capacity, which explained the fact that it was held in the luxurious Charing Cross Hotel. Amongst the many distinguished guests present were to be seen Miss E. C. Bather, O .B.E., Chief Superintendent, Metropolitan Women Police ; Assistant Commissioner Capt. Rymer Jones, O.B .E., M.C.; Chief Superintendent J. Lucas, O.B.E., City Police; W. B. Richards, M.V.O., Chief of B.T.C. Police; Col. N. McK. Jesper, Chief of B.T.C. Police (London Area) and many others. The Trophy had been presented for annual competition by Mrs. Lucas, wife of Chief Superintendent Lucas, and the three teams competing that evening were those who had survived the ordeals of the preliminary eliminating competitions. When the arrangements are in the hands of Mr. F. A. Trott, the General Secretary

A whitlow is an abscess occurring in a finger or toe, and is characterized by the usual symptoms of inflammation similar to those of a boil. A septic wound results when germs have entered. It looks unhealthy and may be covered with a yellowish material which often discharges pus. All these conditions should be referred to a doctor since medical research has led to new and successful methods of treatment. Many hospitals, for example, have now established whitlow clinics whereby the length of the ailment is considerably curtailed. The correct treatment, therefore, for all these conditions is to refer the patient to a doctor without delay, withholding treatment to prevent the patient from procrastinating in his visit. Pain in the abdomen.-Numerous conditions, some minor and many serious, give rise to acute abdominal pain. Causes include colic, appendicitis, obstruction of the bowels, gall-stones, stone in the kidney,

rupture and many others. Less acute abdominal pain-more of the dull ache- may be due to gastric and duodenal ulcers, indigestion, etc. Study of these ailments is outside ~he scope of pure first aid although It may be very important in elementary nursing; hence they will be discussed in a later article for the benefit of advanced first-aiders , particularly those who have to work in isolated districts where medical aid may not be readily obtainable. Some of these causes, however, have been mentioned in order to emphasize the danger of giving advice to patients or their relatives who may apply to first-aiders for treatment in an emergency. The advice must always be the same, namely' see your own doctor without delay.' Some of the conditions mentioned, may require urgent medicalor surgical treatment. An appendicitis, if neglected, may set up an abscess leading to peritonitis and endanger life. A first-aider who recommends treatment for a case of acute abdominal pain assumes a very grave responsibility.

City and B.T.C. Women Police of the Southern Reg ion (B.R.) Ambulance Centre, one must be prepared for any surprise. He had conceived the idea of concentrating upon Artificial Respiration, but had introduced a complication in the form of the ' nuisance,' although in this case the' nuisance' proved to be a second casualty. As each team entered the arena the leader was handed a card which read :'You are required to give a demonstration for a period of five minutes. Bearer No. 2 to perform Schafer's method of Artificial Respiration on patient provided. Bearers Nos. 3 and 4 to perform Schafer-Holger-Nielsen method of Artificial Respiration on patient provided. Bearer No. 1 (Captain) to explain to the audience any necessary points to complete the demonstrations.' The detailed marking sheet, which I was privileged to inspect, was a severe one. Four minutes after the start of the test, an elderly, well-dressed gentleman (who had imbibed well) entered the room and began to make himself a nuisance. When told to go (at a signal five minutes) he said' Alright, I will go,' and merrily turning round, lost his balance, falling to the ground. Injuries: Fracture of neck of right femur and (after a further two minutes) apoplexy. In addition to the team test there was a dual practical test in which two of the bearers had to treat a casualty suffering from a wound on the side of the head accompanied by compression. The team test was judged by Dr. D . Towle, of London, and the dual test by Dr. T. P. Howkins, of Eastleigh.

At the presentation ceremony the Chair was taken by Regional Staff Officer H . C. Lang, who expressed his pleasure in seeing the three teams meeting in friendly rivalry. He then asked Dr. Towle to comment upon the team test. D r. Towle said it was no t his test as he had been called upon at the last moment to deputize, but he had thoroughly enjoyed it. He congratulated the three leaders for the manner in which they had described these methods of Artificial Respiration. On the whole, the performance had been excellent, but there was a tendency to place the hands too low. Fingers should point to the ground so as to obtain the greatest spread. Timing was still weak and sometimes too quick, and he explained to them the physiology of respiration . Referring to the 'happy drunk ' who had interrupted, he explained how easily the neck of the femur can be fractured by just swivelling round, especially as the man was supposed to be over 60 years of . age. The results were as follows :(Maximum marks possible 4(0) M arks B.T.C. 359 C~y 350+ Metropolitan 339 Mrs. Lucas then presented her own Trophy to the winning team, and was herself presented with a beautiful bouquet. A very pleasant evening concluded with thanks to the judges and to Mr. Trott, who had been responsible for the arrangements.

FIRST AID & NURSING, JULY/AUGUST 1955

The St. John Ambulance Brigade Competition Finals THERE are two magic words which, more than any others in our vocabulary, are calculated to supply a stimulus to any St. John man or woman amounting almost to the miraculous. Those two words are , Dewar' and 'Perrott.' They stand for the two coveted Trophies for which ambulance and nursing divisions respectively strive annually at the Brigade Competition Finals. This year no less than 11 men's teams and 12 women's teams reached the Finals at the Central Hall, Westminster, when the contest in each case was a stern one. The Competitions were under the direction of Lt.-General Sir Otto Lund, K.C.B., D.S.O., Commissioner-in-Chief, assisted by the Countess Mountbatten of Burma, c.r., G.B.E., D.C.V.O., Superintendent-in-Chief, Major A. C. White Knox, O.B.E., M.e., M.B., Ch.B., Surgeon-inChief and Dr. M. M. Scott, Deputy Surgeon-in-Chief. The tests were as interesting as ever, as will be seen from the following descriptions :Men's Team Test: The team is called to attend to the injuries received by a milk-bar manager who has been attacked by a 'Teddy boy' with a bicycle chain. A policeman does not arrive until half-way through the test. The victim's wife is also present. Injuries: Bruise of forehead with concussion; wound, front of right wrist, with glass firmly embedded; simple fracture of right leg. The test was set and judged by County Surgeon F. W. Hebblethwaite, M.B., Ch.B. (N.R. Yorkshire). Women's Team Test: A school-girl rushes out of a house and informs the team that her mother has met with an accident. They find the mother lying on her side with her foot caught in the flex of a wireless set. Amongst other things on the table is a bottle which has contained aspirins. . Injuries:. ASI?iri? poisoning, developing mto asphYXIa; lOClsed wound of right hand with bleeding; fracture of right patella; shock (apparent upon recovery from asphyxia). The test was set and judged by Area Surgeon M. C. Cooper, M.e., M.R.C.S., L.R.e.P. (Cornwall). Men's Individual Tests (First Aid) : No.1: Called to a lonely cottage by an old lady, and finds the victim lying on the floor. Injl:'ries : Wound of scalp with slight (ceas 10 g) ~~emorr~age 5 i? above right ear; S~splclOn of uregulanty (fracture) of underlymg skull;. concussion (coma); extenSIve burns (blIsters) on right ann.

Inquiry discloses that District Nurse is expected shortly to dress patient's ulcerated leg. The test was set and judged by Divisional Surgeon A. M. Pollock, M.B., B.Ch. (Kent). Nos. 2 and 3: They are called by a neighbour to a flat where they find an elderly man, who lives alone, lying on the floor. Injuries: Apoplexy, pupils fixed and unequal; scalds on hands (blisters); breath smells of mm ; smell of gas and gas tap discovered ' on.' The test was set and judged by County Surgeon T. E. Wood, M.R.C.S., L.R.C.P. (plymouth, S. W. Devon and E. Cornwall). No.4: The victim is a boxer in a boxing tournament. Injuries: Fracture of right clavicle; nose bleeding; nerve shock. The test was set and judged by Divisional Surgeon J. C. Graham, M.R.C.S., L.R.C.P. (London District). . Women's Individual Tests (Nursing) No.1: Lay up tray and demonstrate washing patient's hair; describe method of giving blanket bath. The test was set and judged by County Cadet Officer Mrs. P. E. Taylor, S.R.N. (Suffolk). Nos. 2 and 3: Mrs. Smith, 73, and partially paralysed down right side, is improving and can walk with assistance. Make bed and assist patient back to bed, make her comfortable and act as you think fit. The test was set and judged by Cadet Superintendent Miss P. Goodall, S.R.N., S.e.M. (Leicester). No.4: Patient has had a cough with loss of weight. She has a very dirty mouth. On bedside table there is a bowl containing thick fluid stained with bright red frothy blood. She is thirsty. Act as you should. The test was set and judged by County Nursing Officer Miss B. H. C. Sammons, S.R.N. (Bristol). Judges of Uniform were: Afen: Dist. Staff Officer E. W. -Haines (London District); Corps Staff Officer S. S. Yeman (Kent.) Women: Dist. Supt. Mrs. M. Cavendish (London District); County Supt. (N) The Lady Teynham (Kent). Referees: Nursing: Major A. C. White Knox, O.B.E., M.C., M.B., Ch.B., Surgeon-inChief. First Aid: Dr. M. M. Scott, Deputy Surgeon-in-Chief. At 3.15 p.m. the Mayor and Mayoress of Westminster, Councillor and Mrs. Spurling, arrived and were received by the Commissioner-in-Chief, Sir Otto Lund. Fifteen

minutes later the Countess Mountbatten of Burma was announced and was received by the Commissioner-in-Chief and the the Mayor and Mayoress of Westminster. A guard of honour was formed by the men and nurses of the teams which had taken part in the Competitions earlier in the day. The party was then conducted to the stage which had been the scene of the Women's Team Competitions, where they witnessed a demonstration, consisting of the· team test, by the Chelmsford Nursing team under its leader, Div. Supt. (N) J. G. Denney, whil'st the judge, Dr. M. C. Cooper, gave an interesting running commentary, explaining each point as it arose. At the close of the demonstration all the members of the team, together with the judge, were presented to the Countess Mountbatten. From there the party passed to the scene of the Men's Team Test, where a demonstration was staged by the Cambridge City Police Team, under its leader, Div. Supt. L. E. Whitfield, accompanied by an equally interesting running commentary by the judge, Dr. F. W. Hebblethwaite, after which all the members of the team, and the judge, were presented to the Countess. During the interval which followed, a most enjoyable organ recital was given by Div. Supt. F. E. Clifford, S.J.A.B. (Midland Bank Division, London District). Presentation Ceremony At the Presentation Ceremony the chair was taken by the Commissioner-in-Chief, Sir Otto Lund, who was supported by the Countess Mountbatten of Burma, Superintendent-in-Chief; the Mayor and Mayoress of Westminster; Brigadier Sir Stewart Duke-Elder; The Hospitaller, Order of St. John of Jerusalem; Brigadier T. D. Daly, e.B.E., M.C., M.A., Deputy Commissioner-in-Chief, Mrs. B. Grosvenor, C.B.E., Deputy Superintendent-in-Chief, Major A. C. White Knox, O.B.E., M.e., M.B., Ch.B., Surgeon-in-Chief; M. M. Scott, Esq., M.R.e.S., L.R.C.P., Deputy Surgeon-in-Chief; Miss N. HamiltonWedderburn, S.R.N., Chief Nursing Officer and the judges. Of the many visitors to be seen were members of the sister organisation, the British Red Cross Society, and we noted specially Air Commodore H. A. Hewat, C.B.E., M.B., Ch.B., D.T.M. & H., and Staff Officer Miss Verdin. High Standard of Interest Opening the proceedings Sir Otto said , On behalf of Headquarters of tb,e St. John Ambulance Brigade it is my pleasure to welcome you all here to-day. I also wish to congratulate the teams who have competed here, for the number of entries represents a high standard of interest.' He then went on to refer to the hard work

FIRST AID & NURSING, JULY/AUGUST 1955 put in by the judges, for without their time and skill these competitions would not be possible. He found it difficult to find words adequately to thank them. With regard to the Competitions, he felt that every year they were getting more realism, and a most valuable contribution to this was made by Associated British Picture Corporation Ltd., who so generously continued to supply and erect the scenery for both Brigade and Association Competitions. He wished, also, to thank the stewards and , patients' who had put in such a hard day's work, and all who had contributed in any way to the success of the event. Turning to Countess Mountbatten he said , I know that it would be your wish to be associated with these expressions of thanks.' He concluded by asking Major White Knox, who had acted as referee, to comment upon the work of the teams. Summing Up Major White Knox stated that he had held a consultation with the judges, and he would give his audience the result in a short criticism and summing up. In both the ambulance and nursing competitions there had been a tendency to msh in and commence operations without due consideration and appreciation of the situation. It was, indeed, extraordinary that so many had failed to wash or sterilize their hands before handLing wounds or dressings. Of bedmaking and approach he could not speak too highly. In the team test some had been puzzled by the aspirins. Had the , patient' felt unwell and taken one or two aspirins to relieve the distressed condition ? They did not jump to the suicidal aspect of the case quickly enough. In the ambulance tests there was a tendency to say one thing and do another, although he admitted that this may have been due to excitement. In the individual tests one or two competitors emphasized the need for sterile conditions-then put on dressings and bandages which had been exposed in their kits for some time! One' patient' had informed him that one leader was in such a state that the perspiration was dripping off him on to the' patient. ' Altogether the work was well up to the standard which they had set themselves. Sir Otto remarked that he hoped that this standard would be maintained. 'We want to be certain that we know our job' he concluded. At this stage the results of the Competitions were announced as follows :~en Afarks 1. Brighton Police 326 (winning the 'Dewar' Challenge Shield for highest aggregate marks, the 'Trimble' Shield for team gaining highest marks in the individual tests, the' Copland Griffiths' Cup for uniform and tieing with Canlbridge City Police for the 'Hingston' Rose Bowl for team test). 2. Wolverton 304 (winning the ' Symons Eccles' Challenge Cup for second aggregate marks and the , Ellis' Challenge Cup for team leader with highest marks in individual tests). 3. British Railways (Canlden) ... 299

4. 5.

6. 7. 8. 9. 10.

11.

(winning the 'Hong Kong' Shield for third aggregate marks). Dean and Chapter CoUiery . .. ... (Durham) .. . Cambridge City Police ... (tieing with Brighton Police for the 'Hingston' Rose Bowl for team test). Pentreroawr Colliery (Wales) ... Shrewsbury Northwich Newton Abbot Markham Main Colliery (W.R. Yorkshire) ... Desborough (Northants)

298 291 t

290 288t 276 27St 272

250

Women 1.

4. 5. 6.

7. 8. 9. lO. 11. 12.

Chelmsford (winning the 'Perrott' Challenge Shield for highest aggregate marks and the' Mountbatten' Trophy for highest marks in team.) Cosham (Hants) ... ... (winning the ' Corbet Fletcher' Shield for second highest aggregate marks, the' Chalmers' Shield for highest marks in individual tests and the 'Marguerite Golding' Trophy for highest marks in Nursing individual tests). Moseley 'A' (Birmingham) (winning the ' Stewart' Cup for third highest aggregate marks and the ' Grosvenor' Cup for unifonns). Southgate (London) Scarborough Atherton ... (winning the' Ellis' Challenge Cup for highest marks for team leader in the individual tests). Minehead (winning the . Lady Mountgarret' Cup for bed-making). Hull Wilberforce (E.R. Yorks) Cobham (Surrey) Bangor (N. Ireland) ... Melton Mowbray and District Tredegar (Wales)

290

287}

283

281 276t 274

270! 264 256 253t 253

249

Responding to the invitation of the Chainnan the Countess Mountbatten said , I would like to thank the Commissionerin-Chief for inviting me to present the trophies. I have been overseas for quite a long time, and have felt very sad at being away from the country. Now, upon my return, I am given the privilege and honour of making these presentations. I would like to add my congratulations to the teams to those already voiced. I saw most of the tests and they were tough.' She said that she was pleased, not only to present the trophies to the winners, but the certificates to all the other competitors, for, although they may not be taking home the trophies, they should feel proud of the fact that they were the winners of their respective Regional Competitions, which

had enabled them to reach the Finals. Since she had been back in this country she had conducted quite a number of inspections, and she had been most pleased with all that she had seen. She was thrilled to find that the standard was still as high as ever. Moreover, she was pleased to learn that the numerical strength of the Brigade had increased since she left England for her journey abroad. The nonnal work of the Brigade was rapidly growing, which was confinned by the fact that during the year 1954 over 4~ millions of hours of voluntary service had-been put in by its members. 'We know what this must mean in sacrifice' she continued, , and I am very pleased with the work of both officers and members, milny of whom have been with us for many years, and I feel proud of being one of these.' She would, however, like to see the work more evenly distributed, for often too much is put on the older members. They still wanted more members. Tme, Cadets were transferring to the Senior Brigade, and this did tend to lighten the burden, but there must be more recruiting. She had been very pleased to note the large number of N.H.S.R. badges there that day, and she also thanked them for their endeavours to build up the V.A.D's in Naval Hospitals. All the services wanted more V.A.D. help. Never had st. John been asked for help in vain. She was pleased to see representatives there that day from different parts of the Commonwealth. 'As you know' she said, , my husband and I have to travel to all parts of the Commonwealth, and it has been very gratifying to see the progress which is being made all over the world by this great organization .' She hoped that all those there that day from the Commonwealth would take back her message of goodwill. 'I wish to thank you, Sir Otto, and all my colleagues, for I know that you will continue to carryon this great work' she concluded. The Countess then presented the trophies to the winning teams, shaking hands with each member as he or she passed the dais. Brigadier T. D. Daly, Deputy Commissioner-in-Chief, then proposed a vote of thanks to the Countess for so graciously acceding to their request to present the trophies . It needed no words of his, he said, to express what they all thought of her. She was always thanking others, but never sought thanks for what she did herself. 'She sets us a supreme example' he concluded. A vote of thanks to the Mayor and Mayoress of Westminster for their everready support brought to a close a most successful event, the arrangements for which had been in the competent hands of Mr. G. F. Quilter, M.B.E., the Brigade Secretary. From Kenya Two distinctive uniforms, obviously St. John, but quite strange to this country, attracted our attention, and we soon found ourselves in conversation with Colony Cadet Officer J. M. Bennion and Nursing Superintendent Mrs. Bennion, from Kenya, and it was most gratifying to learn of the enthusiasm shown in the work in this part of the world, despite the difficulties now being encountered. 'First Aid Gild NlIrsing' sends greetings to Kenya.

FIRST AID & NURSING, JULY/AUGUST 1955

The St. John Ambulance Brigade Cadets~

ANY fears which may previously have

been entertained as to the future of the Brigade after the present senior members have passed on were permanently dispelled by the performances of the Cadets at the Annual Cadet Competition Finals, held at the Central Hall, Westminster. No less than 44 teams from all parts' of England, Wales and Northern Ireland had entered, and it was most creditable that, despite the difficulties of travelling, occasioned by the railway strike, not one failed to arrive. The competitions consisted of team, dual and individual tests, and the manner in which they were tackled would certainly have made many seniors sit up and take notice. Moreover, the tests were by no means easy, but for all that, they appeared to present little difficulty to these enthusiastic young people. Cadets are divided into two age groups, viz., Junior, trained according to the junior course, and Senior, who use the same manual as that studied by the senior members of the Brigade. Following are synopses of the tests. Senior Ambulance Team Test The members are passing an isolated cottage when an explosion, caused by gas from the oven, wrecks the kitchen and knocks out the householder who was responsible for the accident. Irjuries: Bums of face (blisters), simple fracture of left leg and a wound of left forearm with a wood splinter firmly embedded. The test was set and judged by Dr. R. G. Sprenger, Area Commissioner, Noltinghamshire. Senior Nursing Team Test This team, also, is passing an isolated cottage and are attracted by a woman's screams. Upon investigation they find that a boy has tripped over the flex attached to his mother's electric iron, which falls on to the outstretched arm of the prostrate boy. Injuries: Simple fracture of right clavicle, bruising right side of forehead, burn of left calf (blisters) through the stocking, and shock. The test was set and judged by Dr. G. Pari Huws, Deputy Surgeon-in-Chief, Priory for Wales. Junior Ambulance Team Test The members of the team come across a motor cyclist who has, obviously, met with an accident. ~e is lying on his face, apparently unconscIOUS. Injuries: Head wound, simple fracture of shaft of right femur, grazes of right side of face. The test was set and judged by Dr. Ian Mackenzie, Area Commissioner, Derbyshire. Junior Nursing Team Test A cyclist collides with the car in which the team is travelling to a picnic. lnfuries: Wound on forehead, with some haemorrhage, dislocation of left shoulder, fracture of left leg and shock. The lady

National Finals

car driver, who panics but is not injured, also has to be attended to. The test was set and judged by Dr. G. M. Shaw Smith, Area Comntissioner, London District. Referees: Major A. e. White Knox, O.B.E., M.e., M.B., Ch.B., Surgeon-inChief (Nursing Cadets), Dr. M. M. Scott, Deputy Surgeon-in-Chief (Ambulance Cadets). Senior Ambulance Dual Tests Nos. 1 and 2 have to treat an epileptic who has fallen and sprained his ankle. This was set and judged by Dr. e. J. P. Seccombe, Divisional Surgeon, London District. Nos. 3 and 4 are called upon to treat a boy who has had a sledging accident, and is suffering with a fractured left patella and right clavicle, also shock. This was set and judged by Dr. D. W. Hendry, Corps Surgeon, Warwickshire. Junior Ambulance Dual Tests Nos. 1 and 2 are called upon to render first aid in a case of electric shock with asphyxia. This was set and judged by Dr. J. S. Hamilton, Area Surgeon, Staffordshire. Nos. 3 and 4, calling upon their grandfather, find him lying on the floor. Examination discloses that he is suffering with a lacerated scalp and fractured ribs. This was set and judged by Dr. J. Clay, Area Surgeon, Hertfordshire. Senior Nursing Dual Tests Nos. 1 and 2 are instructed to nurse a case of measles at home. They have to prepare the room and make whatever arrangements are necessary in view of the infectious nature of the case, and to adopt the special precautions necessary for nursing a case of measles. This was set and judged by Miss G. Riley, S.R.N., County Nursing Officer, Oxford. Nos. 3 and 4: Patient in bed with fracture of left leg. Under-sheet and drawsheet have to be changed. This was set and judged by Miss N. Clinton, S.R.N., County Nursing Officer, Birmingham. Junior Nursing Dual Tests Nos. 1 and 2: Patient suffering with sudden lung affection. No. 1 must take T.P.R. and record on chart. No. 2 must prepare mouth tray and describe method of keeping mouth moist and cleaning teeth of helpless patient. This was set and judged by Miss P. Hyde, S.R.N., R.S.e.N., S.e.M., Area Nursing Officer, Duke of Lancaster's District. Nos. 3 and 4: As for Nos. 3 and 4, Senior Dual Test above. This was set and judged by Miss E. J. Wollaston, S.R.N., S.e.M., County Staff Officer (Cadet Training), Leicestershire. At 3.10 p.m. The Chancellor of the Order of St. John (Lt.-General Sir Henry Pownall, K.e.B., C.B.E., D.S.O., M.C.), the Comntissioner-in-Chief, S.J.A.B. (Lt.General Sir Otto Lund, K.C.B., D.S.O.), and the Superintendent-in-Chief, S.J.A.B. (The Countess Mountbatten of Burma,

e.r., C.B.E., D.C.YO.) received the Mayor and Mayoress of Westminster (Councillor Patrick Stirling, J.P., and Mrs. Stirling), and at 3.20 the party received Brigadier Sir John Hunt, e.B.E., D.S.O., and Lady Hunt. A guard of honour was formed by the members of the Cadet teams who had been competing that day. After witnessing demonstrations given by four of the Cadet teams the party proceeded to the Great Hall, where the Presentation Ceremony was preceded by a most enjoyable organ recital given by Divisional Superintendent F. E. Clifford (Midland Bank Division, S.J.A.B.), London District. Presentation Ceremony The Presentation Ceremony was presided over by Sir Otto Lund, who was supported by Sir John and Lady Hunt, The Countess Mountbatten, Lt.-General Sir Henry Pownall, Councillor and Mrs. Patrick Stirling, Major A. e. White Knox, O.B.E., M.e., M.B., Ch.B. (Surgeon-in-Chief, S.J.A.B.), Mr. Horace F. Parshall, T.D., M.A.(Oxon), (Director-General, S.J.A.A.), Brigadier L. D. Daly, D.S.O., e.B.E., M.C., M.A. (Deputy Commissioner-in-Cruef, S.J.A.B.), Brigadier A. Ritchie, D.S.O. (Assistant Commissioner-in-Chief) and Miss Virginia Cunard, M.B.E. (Chief Nursing Officer, Cadets). It was, also, very gratifying to see a number of guests from the British Red Cross Society on the platform, and amongst others we noted MajorGeneral L. A. Hawes, e.B.E., D.S.O., M.e., M.A. (Controller, Home Department, B.R.e.S.), Air Commodore H. A. Hewat, e.B.E., M.B., Ch.B., D.T.M. & H. (Medical Adviser, B.R.e.S.) and Dame Beryl Oliver, G.B.E., R.R.C. We would like to see a more frequent mingling of the uniforms, not only at top level but of the rank and file. All Teams Turned Up Opening the proceedings Sir Otto Lund said ' It is a great pleasure to see so many here to-day, and I am particularly pleased to tell you that, despite the difficulties of travel caused by the (railway) strike, all teams which had entered had turned up.' He went on to say that it had given them all a thrill to learn, when they made enquiries, that not one intended to withdraw on account of the travel difficulties. He also wished to say how glad they were to have the Mayor and Mayoress of Westminster with them. These dignitaries always made a point of attending whenever the events were held in their city. The Commissioner-in-Cruef then extended to Sir John and Lady Hunt a most cordial welcome. They had, he said, come up from Camberley that day especially to present the awards to the suctessful Cadet teams, a fact which the Cadets would appreciate most highly. The Cadets had had a good year, and had increased their numbers since last he had addressed them. , The future of the Brigade is in your hands' he reminded them. 'The Cadets of to-day are the adult members of to-morrow.'

FIRST AID & NURSING, JULY/AUGUST 1955 He was pleased to note that they were getting more and more trained Cadet leaders, and a part of the grant which they had received from the George VI Memorial Foundation would be spent upon the training of Cadets. He sincerely hoped that those who would be called upon to do National Service would come back to them at the end of their training. Sir Otto said that he would like to take that opportunity of thanking once again the judges, who were always so willing to give their time and skill, the stewards, 'patients,' 'onlookers,' the Associated British Picture Corporation Ltd., who were always so ready to supply, erect and remove the scenery, and Mr. Quilter, the Brigade Secretary, who had been responsible for all the arrangements. They were all sorry to learn that Miss Cunard, to whom the Cadets owed so much, would be unable to continue her valuable work. By her efficiency, imagination and new ideas she had contributed much to the success of the Cadet movement. The results of the Competitions were then announced as follows : Marks Senior Ambulance 1. Grays, London 270 (winning the 'White Knox' Cup for team with highest marks in all tests, the ' New Zealand' Cup for team with highest marks in the Individual test, and tieing with Horsham for the 'Lowe' Cup for team with highest marks in team test.) 2. Horsham, Sussex 269i (winning the 'Pownall' Cup for team with second highest marks in all tests, and tieing with Grays for the 'Lowe' Cup for team with highest mClrks in team test.) 249t 3. Glynneath, Wales (winning the Third Prize.) 4. Newton Abbot, Devon 245i 5. Letchworth, Herts 244t 6. Thorne Colliery, W.R. Yorks... 236t 7. Carbrook, Cheshire 22lt 8. Wolverton, Bucks 202l 9. Hereford City ... 198t 10. Ireland Colliery, Derby 196

Marks Senior Nursing 1. Harrow, London 282t (winning the 'Mountbatten' Cup for team with highest marks in all tests, the , Senior Individual' Cup for team with highest marks in the Individual test and the , Tweedale' Cup for team with highest marks in Home Nursing test, Senior or Junior.) 2. Southwick, Sussex 279 (winning the 'Pownall' Cup for team with second highest marks in all tests.) 275t 3. Ballymena, Ireland ... (winning the Third Prize.) 274t 4. Kington, Hereford 5. Liverpool South, Lanes 271t 6. Tredegar, Wales ... ... 269t (winning the 'Bedmaking' Cup for team with highest marks for bedmaking, Senior or Junior.)

7. 8. 9. 10. 11.

Torquay, Devon Banbury, Oxford Rothwell, Northants Bingley, W.R. Yorks Cambridge City

266 25n 254t 242 225

Junior Ambulance

Marks Norwich No.1, Norfolk ... 261 (winning the' Schooling' Cup for team with highest marks in all tests, the' Jarvis' Cup for team with highest marks in the Individual test and tieing with Fairbairn House for the 'Barne' Cup for team with highest marks in the Team test.) 2. Fairbairn House, London 253t (tieing with Norwich for the , Barne' Cup for team with highest marks in the Team test.) 3. Donisthorpe, Leicester 248 4. Bryn, Wales 242 5. Dean and Chapter, Durham 2311 6. Penzance, Cornwall 229 7. Lancing and Sompting, Sussex 226l 8. Farnworth, Lancs 203! 202 9. Ludlow, Shropshire 10. Oxford City 194t 11. Markham Main, W.R. Yorks 176t 1.

Junior Nursing 1.

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Marks Coalville, Leicestershire 287t (winning the 'Dunbar-Nasmith' Cup for team with highest marh in all tests, and the ' Cunard ' Cup for team with highest marks in the Individual test.) Harrow, London 275t Stockton and Thornaby, N.W. 235 Yorks 234 Redruth, Cornwall 231t Weymouth, Dorset 228t Great Yarmouth, Norfolk 220 Harrogate, W.R. Yorks Shrewsbury No.1, Shropshire 215t 213t Lancaster, Lanes 205 Treharris, Wales 160i Folkestone, Kent 152t Ballymena, N. Ireland

Major White Knox, Surgeon-in-Chief, who had acted as referee, then commented on behalf of the judges. It was, he said, his difficult task to assess the values of the work which they had seen that day. In referring to competitions generally he raised a new and interesting point. Standard setting and make-up had now reached a pitch which often enabled the teams to recognize the condition immediately- spot diagnosis. Was this a good thing? The students were taught by their text-books and their lecturers to build up their diagnosis point by point, ultimately arrivin~ at their conclusion by a process of deductIOn. The marking sheets contained a mass of details for which the students were awarded marks. He gave an example of what he meant. A compound fracture might be so well' faked' that the nature of the injury would be immediately apparent, instead of it having to be deduced by the classic signs and symptoms. He felt t~at it. was a question which deserved consideratIOn.

The handling of injuries had not been quite as gentle as he would have wished, and he was sorry to say that even the girls had been guilty of this fault. Artificial respiration, which was so much before the public eye to-day, needs attention. There is a tendency to speed up the rate. Certainly, the respiration rate was slightly higher in young people than in older ones, but many were not quite as young as all that! He would, also, like to see an improvement in the character of the nursing work. The tests might be made a little more complicated, which would tend to increase efficiency. They were inclined to overlook impedimenta in their anxiety to get on with the job. On the whole, however, the general standard of work had been high. The Chairman then invited Sir John Hunt to present the Trophies to the successful competitors. Sir John said that it was a coincidence that he should have been invited to present the Trophies for First Aid and Nursing on the day following that upon which he had had the honour of presenting the prizes at the Royal Medical College. , I certainly felt out of my depth yesterday' he admitted, ' but I have now acquired more confidence.' He had been both thrilled and impressed by the demonstrations he had seen carried out by the Cadets t-hat day, his only regret being that he had been unable to see the Competitions throughout. He congratulated them all, both winners and losers, for he realized how much hard work must have gone into the preparation for the Competitions. 'It is the effort that you put into it that counts' he said. On behalf of everyone he would like to say to them 'Well done!' He was interested in adventure (he was referring to the Everest expedition) but he felt that the word' adventure' was often too narrowly interpreted. He believed that the value of adventure lies in the reaction which follows the hard task, for it was then much easier to perform the simpier duties of life. Adventure takes you away from yourself and forces you to concentrate upon something higher. Anything which demands self-sacrifice, he reminded his hearers, was adventure. 'I believe that your activities in First Aid and Nursing constitute ADVENTURE with capital letters, and are well worth-while. ' His concluding words were 'We are all very proud of you. Keep it up.' The Countess Mountbatten immediately won the hearts of all when she addressed them as ' Colleagues and friends,' and went on to express her pleasure at being ~ack again in this country, and she was es~eclally thrilled to be back in time to attend this great event. Turning to Sir John and Lady Hunt she said 'We are most grateful to you. You have been busy, and we all appreciate all that you have done. It is difficult to find words to thank you adequately. Indeed, I felt that I was presumptuous in writing to ask you to come here to-day, but your ready acceptance reassured me.' She went on to remind her hearers that ~er husband had been privileged to wo~k Wit? Sir John during the war. Despite hiS great achievement in conquering .Everest, they had been impressed by ?is great modesty and reticence. The~ be~Jeved that the secret of his success by 10 hiS courage and perseverence, and she believed that

FIRST AID & NURSING, JULY/AUGUST 1955

those present would never forget that great moment and especially those who had been privileged to receive th~ir Trophies from his hands. She would like to say a word of congratulation, not only to the teams which had won, but to those who had worked equally as hard but just did not quite manage it. The Countess then expressed the appreciation of all to the medical services, and also to ' our colleagues' of the British Red Cross Society the Women's Voluntary Services and at! those organizations which were working for the benefit of their fellow creatures. The audience was deeply touched when she referred with sorrow to the fact that they were losing the services of Miss

Cunard. 'We shall miss you very much, Virginia' she said, an~ there was .not a person in that vast audIence who dId not realize how much those words conveyed. It must, she said, be very gratifying to Miss Cunard to know that over 700 Cadets pass on to take up professional nursing each year. She concluded by saying' It is a great privilege to thank the Mayor and Mayoress of Westminster and Sir John and Lady Hunt for coming here to-day. We shall never forget your kindness.' A great day, the arrangements for which had been in the capable hands of Mr. G. F. Quilter, M.B.E., Brigade Secretary, ended with the singing of the National Anthem.

Visitor from West Indies A conspicuous figure to be seen mingling with the spectators was Mr. Charles D. Guy, from the West Indies, who is in England on holiday, and whom we had met previously at the Inaugural Meeting of the , Save-a-Life' Weeks Campaign at the Chapter Hall, St. John's Gate. Mr. Guy is an officer of the Tobago Division which, he informed us, is over 60 strong. It was most gratifying to learn from him of the enthusiasm of both the ambulance men and nursing sisters in their work. 'First Aid and Nursing' sends greetings to the Tobago Division and trusts that Mr. Guy will carry back many pleasant memories.

NATIONAL HOSPITAL SERVICE RESERVE

Mobile First Aid Units ANNUAL COMPETITION FINALS SELDOM has the Horse Guards Parade, Westminster, presented so spectacular a scene as that which was witnessed by thousands of spectators on Saturday, 2nd July last, on the occasion of the Annual Competitions of the National Hospital Service Reserve Mobile First Aid Units. It was open to all Mobile First Aid Units in England and Wales entered by Hospital Management Committees, Operational Groups or Boards of Governors of teaching hospitals. In all, 240 units had taken part in eliminating contests in the 14 hospital regions. Regional Finals had been held in May and June, and the 14 teams which had qualified for the National Finals to be held that day were divided, by drawing lots, into 3 groups of 5, 5 and 4 teams as follows :Hospital Region:

Team (Board of Governors, Hospital Management Committee or Operational Group)

Group No.1: Sheffield ...

Nottingham No. H.M.e. N.E. Metropolitan Enfield Group H.M.e. Newcastle ... Gateshead O.G.(Queen Elizabeth Hospital) S.E. Metropolitan Orpington and Sevenoaks H.M.C. Group No.2: Leeds

Group Leeds (A) H.M.C. Oxford Oxford and District H.M.e. Manchester United Manchester Hospitals (Manchester Royal Infirmary). S.W. Metropolitan Redhill Group H.M.e. Wales Merthyr and Aberdare H.M.e. (St. Tydfil's Hospital). Group No.3: Liverpool

No. 14 Deva O.G. (Deva Hospital, Chester).

Birmingham

Birmingham (Dudley Rd.) Group H.M.e. East Anglia Ipswich Group H.M.e. South Western Southmead General H.M.e. N.W. Metropolitan WindsorGroupH.M.C. These teams competed within their own respective Groups in the semi-final rounds held in the morning, and the winners of the three Groups, Enfield, Southmead and RedhiJl competed in the Finals in the afternoon. At 2.30 p.m. aU the units, except the three which had been the winners in the morning, and would be competing in the Finals in the afternoon, were drawn up in line on the south side of the Parade for inspection. Behind each unit, which consisted of a medical officer, a trained nurse and eight auxiliaries, were to be seen a 25/30 cwt. van containing equipment, and two private cars or a station waggon for personnel. These were flanked by drivers and wardens from the County of London and Westminster Divisions Civil Defence Corps who were rendering valuable assistance, and finally, Mr. P. G. Sargeant, general secretary of the Casualties Union, of whose activities more anon. As soon as dressing had been taken up the parade was inspected by the Minister of Health, the Rt. Hon. lain Macleod, M.P., who was accompanied by Miss M. P. HornsbySmith, M.P., Parliamentary Secretary; Mrs. A. M. Bryans, O.B.E., representing the British Red Cross Society, Major A. e. White Knox, O.B.E., M.C., M.B., Ch.B., representing the St. John Ambulance Association and Brigade; and Mr. e. L. Bourton, a principal in the Hospitals Division of the Ministry of Health, and who was mainly responsible for the organization of the Competitions and the arrangements on Horse Guards Parade. The Minister of Health shook hands with every member on parade and then proceeded with his party to the Grand Stand to watch the Competition Final for the Minister of Health's Challenge Cup. Here he was

joined by Sir John Hawton, KC.B., Permanent Secretary; Sir John Charles, Ke.B., M.D., FR.e.P., D.P.H., Chief Medical Officer to the Ministry of Health ; Mr. J. E. Pater, C.B., Under-Secretary, Hospitals Division and Dame Elizabeth Cockayne, D.B.E., Chief Nursing Officer. Others on the Stand with the Minister were the Chairman of the various Hospital Boards and Boards of Governors, MajorGeneral L. A. Hawes, C.B.E., D.S.O., M.e., M.A., Controller, Home Department, British Red Cross Society; Miss M. E. Craven, R.R.e., Miss M. HamiltonWedderburn, S.R.N., Chief Nursing Officer, The St. John Ambulance Brigade; Sir Frank Newsam, Ke.B., KB.E., e.V.O., M.e., Perm an ept Secretary, and Lady Newsam; Lord Haden-Guest, Sir Parker Morris, LL.B., and many others. Visitors to Horse Guards expecting to witness a First Aid or Nursing Competition on the lines of those organized by the British Red Cross Society or the St. John Ambulance Association or Brigade were in for a big surprise. Perhaps, therefore, at this stage some explanation may not be out of place. The main function of Mobile First Aid units is to provide immediate medical service in the field for walking and other casualties, for which purpose they would set up temporary first aid posts as directed. In the Competition, therefore, each team is deemed to have been called out from its hospital through the Hospital Group Officer and instructed to report to a specified Post Controller, and to set up a first aid post in a building or part of a building indicated for the purpose, and represented in the Competition by an enclosure. The Medical Officer of the team reports to the Post Controller, who gives him a brief account of the situation, and immediately there follows a period of great activity. The team proceeds to unload and set up its equipment as speedily as possible to be ready to deal with casualties. Stretchers and trestles for temporary beds, chairs, sterilizers, bowls, pails, packing cases containing bandages, dress-

FIRST AID & NURSING, JULY/AUGUST 1955 ings drugs and instruments. Primus stoves are hauled out of the vehicle and quickly arranged according ~o the ~ecision of the M.O. This year an mnovatIOn was noted, in that the casualties began to arrive before the team had completed preparations, thus testing the ingenuity and resourcefulness of its members to the utmost. The doctor diagnoses the cases and the. members, under the direction of the. trame~ n~lfS€?, deal with each case accordrng to Its mdIvidual needs. Some are then sent to hospital some to their homes, assisted by the wardens, according to the seriousness of the case. Marks are awarded for :(1) Turn-out of personnel, discipline uI?on arrival and evidence of clear appomtment of duties. (2) Method of unloading, unpacking and laying out of equipment. (3) General lay-out of unit in buildinguse of rooms, etc. (4) Reception, document~tion, treatment and disposal of casualtIes. It will probably be. asked' Where are the casualties coming from?' Let us find out. On the north-east corner of the great arena we noted a large marquee marked ' Casualties Union,' and a visit to thi~ marquee provided the answer to our questIOn. H~re we found a dozen tables, each coV'ered ~Ith grease paint , plas~icine, sausage skms, pieces of bone, sphnters of. wood, and a great deal of other impedunenta w?<?s.e uses were certainly obscure to the ummtlated. Each table was presided oyer ~y a , faker' whose duty was to 'fake vanous types of injury on. the dozen or so , patients' around hiS or her tab~e. The , patients,' also, had been well bnefed to act according to the type of casualty they were representing. The marqu~e most certainly presented some ghastly SIghts, for the members of the Casualties Union, all of whom are skilled first-aiders, have m~de an exhaustive study of' faking' and actlDg. We saw compound fractures, crushed limbs gaping wounds with severe haemorrhage,' wounds of .the abdo~al wall wi~h intestines protrud1Og (plastlclD~ encased 10 sausage skins and ~moth~red WIth red dye), a 'patient' suffenng WIth smallpox, unconscious 'patients' wit? he,ad ~nd ~ther injuries, epileptics, hystencal .patlents, .one poisoned by carbon-monoxIde, spramed ankles, dislocated shoulders . and many others too numerous to mentIon. Th~se, then, were the casualties which were belDg carried into the arena on stretchers for the teams to deal with. At one table we found Mr. E. C. Claxton, the organizer for study circles, preparing the briefs. At another was Mr. P. G. Sargeant, th~ general secretary, with his ~ssist.ant~ MISS W. A. Elston directing the faking, and all un.der the expert supervision of Dr. A. L.. WIlls. Some idea of the magnitude of theIr task may be gathered from the fact that 48 , patients' had be~n provided for the preliminary rounds In the mormpg at:Jd 90 were being prep'ared for the Fmais ID the afternoon, which were, of course, much more severe. , Escaping from this' chamber of horrors what could be more welcome than the marquee marked '~efr~shments,' for which we made a bee lIne 10 double qu.~ck time? Here we were met by a chanmng lady who piloted us to a tab~e and .made certain that we were served ImmedIately. We soon learned that this was Mrs. Q. Gardener, Feeding Specialist, London

County Council, who was in charge of this marquee which was most efficiently staffed by members of the Women's Voluntary Service. Mrs. Gardener informed us that she had a staff of 20 ladies who were attending to the gastronomic needs of t?e vast number of visitors there. Those ladles certainly earned our grateful thanks. Loth to leave this marquee we passed to the n0rth-western corner, where we found a first-aid post had been established to deal with any REAL accidents whic? might occur in so great an assembly. SIX nurses from St. George's Hospital and some N.H.S.R. auxiliaries, a driver and a porter, under the direction of Dr. P. L. Berger and Sister R. Taylor, had volunteered to staff this post, which we were privileged to inspect, and which we found t~ be completely equipped to meet any hkely contingency. Indeed, at the end of the day Dr. Berger and Sister Taylor iI?formed us that their services had been requrred to deal with about a dozen REAL casualties, both maior and minor. Let us say' Thank you' to these angels of mercy. On our way back we stopped to chat ,!,,!th Divisional Director Mrs. D. Scott, Bnt1~h Red Cross Society (Lewisham) who was m charge of propaganda and information. Here we saw a display of photogr.aphs depicting the many activities of the NatIOnal Hospital Service Reserve, and Mrs. Scott was prepared to answer any questions p.ut to her regarding this most valuable orgamzation. During the day a most enjoyable programme of music was played by the famous band of the Welsh Guards, under th.e baton of Band-Sergeant-Major S. T. WhItehead, B.E.M. (deputizing for their Director of Music, Captain F. L. Statham, L.R.A.M., A.R.e.M., p.s.m.), th, ough the courtesy of Col. D. G. Davies-Scourfield, M.e., Commanding the Regiment. The Competitions ended, all eyes were then turned to the Grand Stand, where the vast assembly was addressed by Mr. Macleod, the Minister of Health. 'I have no illusions as to why I have bee£? asked t.o speak to you at this tim€? ' he sa.Id. 'It IS merely to fill in time whIlst the Jud~es are totalling up their marks and tryI~g to arrive at the winner' (lau~ter). ~hls ~as the third annual CompetItion of ItS kmd, he told his hearers, but the. second on a national basis, the first havI~g been c~m fined to the four Metropolitan HospItaL Regions. It was, however? most ~n couraging to see the CompetItI~n grow~ng year by year, and the large au<;lience which they saw there that d~y was eVI~enc~ of the increasing interest belOg take~ 10 this work by the public. He would lIke to ~ay a special word to .those who. competed. m the morning but dId not qUlte make It. He would like to congratulate them for, he reminded them, although. they had not been quite winners at the Fma~s, they we!e, after all champions of theIr respectIve Regions,' otherwise they wou}d not have reached the Finals at all. This was something to be proud of. Special tha~~s were accorded by the Minister to the BntIsh Red Cross Society and the St. John. Ambulance Association and Brigade, for It was from the ranks of these two bodi~s that th;e N.H.S.R. was recruited, and WIthout t.herr help the Reserve would not be. pOSSIble. He wished, also, to thank ~e ladies of the Women's Voluntary ServIce who had

ministered so admirably to the needs of the inner man. Units of the City of London and Westminster Civil Defence Corps had rendered yeoman service by providing motor cyclists, wardens, etc., whose help had been indispensable. Mention of the Casualties Union brought a volley of applause. This year, he thought, the casualties had been better than ever, both in 'faking' and in acting, and he made special mention of the 'bank manager' who acted the part of the hysterical recipient of bad news. It reminde~ him of a civil servant (he is, of course, hImself a civil servant) trying to get home after a hard day at the office! (laughter). Mr. Macleod asked them, however, to consider seriously al1 that lay behind what they had seen that day. He believed that international tension was lessening, but, even if peace were nearer, as they all. hoped, all this training was well worth while. It was, after all, part of the strength of t~s coU?t.ry, and those who had received this trammg were the better equipped to cope with the ordinary tasks of life because of . t~at training. Last year no less than 1t rrulllOn cases had been treated by members of th.e National Hospital Service Reserve. TheIr target was 100,000 members, and he. felt sure that everyone there would do his or her best to help to recruit others in order that that target might be achieved. 'What you have seen here to-day' he .said,' is only a part.' Trained nurses are m short supply, and the members of the N:H.S.R. can give valuable help to th~ hopsltals by their voluntary serVIce, which IS always most welcome. Before announcing the. resu~ts the Minister paused to pay specIal .tnbute to the judges, Sir Ernest Rock Carling, M:B., F.R.e.S., F.R.e.P., Consultan~ AdVIser to the Minister of Health; SIr Claude Frankau, e.B.E., D.S.O., M.S., F.~.e.S. , and Major-General W. E. R. Dunond, e.LE., e.B.E., L.R.C.P.I., L.R.e.S.I. , D.P.H., the two latter . 0'£ whom were Medical Officers of the MInIstry of He~lth. These three eminent scienti~ts h~d ~acnfied their time and given of thelf skill m order to further this great work, and he felt that no words of his could adequately thank them for their valuable support. Mr. Macleod thanked the Band of the Welsh Guards, on behalf of all present, f~r a most enjoyable programme of mUSIC during the day. . At this stage the results of the FlOa),.for which everyone had been anxiously waItrng, were announced :1. Enfield Group H.M;.e., rep.resentin~ the N.E. MetropolItan RegIOn. 2. Southmead General H.M.e., repres~n ting the South-Western HospItal Region. . 2. Redhill Group H .M.e., Mrepresenl~tmg the South-Western etropo I an Hospital Region. The last two tied for ~econd. place, the judges being unable to deCIde which of t~em 'was the better. RedhiIJ, h<;)\~~ever, rec.elved a special cheer when the MIOIster rerrunded his hearers that this was an all-women team. Shaking hands with each member ~r. the t Mr Macleod presented the MIDlster ofa~ealth\ Chal1enge Cup to the Enfield t am after which the two runners-up, Seoutlunead and Redhill, were also presentee! to him.

FIRST AID & NURSING, JULY/AUGUST 1955

FIR ST AID & NURSING, JULY/AUGUST 1955

B.T.C. (Railways and Docks) and B.T.C. Police Na tional First . ~id . Competitions pREVIOUSLY known as the British Railways Competition, the British Transport Commission (Railways and Docks) National First Aid Competition combined with the British Transport Commission Police Competition in one big event this year, which was held at the Central Hall, Westminster. The trophies to be competed for by teams from the first organization were the Challenge Shield and Corbet Fletcher Cup (open to teams of men) and the Burrows Rose Bowl (open to teams of women), those for the Police teams were the Sir Bertram Ford Challenge Shield and the Chiefs of Police Cup. No less than six tests were in progress simultaneously, as well as oral questions, surely a gigantic task of organization for Mr. George Craft, the capable and experienced competition secretary. It would take much more than this, however, to worry Mr. Craft. The team test for Railway Men, set and judged by Dr. Allan Walker, of Wolverhampton: The members of the team see a lorry with a high and insecure load swing round a corner, then the load collapses and knocks over a cyclist who is buried in the debris. The patient's answers to questions are rather incoherent and spoken with difficulty. Injuries: Fracture of lower right ribs with bruising over liver region, compound fracture of right leg, shock. Later signs and symptoms suggesting internal haemorrhage. The team test for Railway Women and B.T.e. Police, set and judged by Dr. R. V. S. Cooper, of Weymouth: The members of the team are sitting in a railway compartment when a man is pushed hurriedly into the compartment by his two friends who bid him a hurried , Good-night' as the train moves off. The patient is obviously in pain and states, upon being questioned, that he has fallen down the bridge steps on to his back. Injuries: Fracture of third lumbar vertebrae, bleeding from varicose vein of left calf. The test is made more difficult by the restricted space in the compartment. Dual Practical Tests for Railway Men, set and judged by Drs. Robert Piper of Slough, and A. Conn of Ewell : Nos . 1 and 3: Find a man lying at the foot of a pair of steps near a hanging light. Injuries : Swelling over occiput, concussion , fractured base of skull, simple fracture of right patella. Nos. 2 and 4: Called to assist a man who has received a heavy blow on the jaw in a street brawl, and is found lying on his right side. Injuries: Fracture of jaw, concussion, wound of palm of left hand with underlying fracture of carpel bones. Dual Practical Tests for Railway Women and B.T.e. Police: Nos. 1 and 3: See a man stumble upon leaving the refreshment room on a railway station. Station is quiet, weather cold and one porter available. .

Injuries: Diabetic coma, simple fracture of right radius, shock. Nos. 2 and 4 : Passing a warehouse and see a packing case drop from a crane, striking a workman who falls to the ground. Injuries: Laceration of scalp with depressed fracture, compression, fractured clavicle. At the presentation ceremony after the conclusion of the tests, the Chair was taken by Mr. Horace F. Parshall, T.D., M.A. (Oxon), Director-General of the St. John Ambulance Association, under whose auspices the Competitions were held. He was supported by General Sir Brian Robertson, Bt., G.e.B., G .B.E., K.e.M.G., K.C.V.O., D.S.O., M.e., Chainnan of the British Transport Commission and Lady Robertson, Lt.-General Sir Henry Pownall, K.e.B., K.B.E., D.S.D., M.C., Chancellor of the Order of St. John, Major A. e. White Knox, O.B.E., M.e. , M.B., Ch.B., Surgeon-in-Chief, S.J.A.B., Brigadier L. D. Daly, D.S.O., e.B.E., M.e., M.A., Deputy Commissioner-in-Chief, S.J.A.B., and the judges. Opening the proceedings Mr. Parshall expressed his pleasure at being present once again at this most important Final, and extended a cordial welcome to Sir Brian and Lady Robertson, who had kindly consented to present the awards. Of the many distinguished guests who had accepted invitations to be present he wished especially to thank Sir Henry Pownall, the Chancellor of the Order. The Chancellor, despite his many duties in connection with his high office in the Order, never failed to be present at these competitions whenever possible. He also would like to thank Brigadier Daly for the interest he had always shown in these events. The' patients' and stewards deserved both their sympathy and thanks, and the Associated British Picture Corporation Ltd. had once again been good enough to supply, erect and remove all the splendid scenery and props, which gave the tests so much realism. The judges, who were prepared to give their time and skill, were very much appreciated, and he proposed to ask them to comment upon the work they had judged that day. Dr. Walker, who had judged the men's team test, was the first speaker. He felt it a great privilege to be asked to iudge this test, and he congratulated the teams upon some good work. The test had been a comparatively straightforward one, and all had diagnosed the case correctly, although there had been a little uncertainty as to the exact position of the liver. They must, however, try to gain more experience in carefully handling injured persons. In the case of fractures, once they had taken hold of them they must not let go until they had been immobilized. Dr. Conn, who had judged the Railway Men's Dual Practical Tests, had asked him to say that he had been a little disappointed in the bandaging. It should be as neat as the illustrations in the te'<t-books. He concluded by assuring them that the judges were always anxious to be as helpful as possible.

The Repair

Dr. Cooper, who had judged the Women's and B.T.e. Police Team Test, endorsed Dr. Walker's congratulations upon the excellent work of the teams. They must, however, try to acquire a better appreciation of what is happening. He would like to see a little more care taken of the patient's effects when it is necessary to empty his pockets. Twice the patient's keys could not be found, and they were eventually recovered from the most extraordinary places-in one case packed in a handkerchief! The test was a trifle difficult, but, on the whole, the work had been good . All managed to get the patient to hospital in a reasonable time, and this was most important. Mr. Craft then announced the results:

Squad When you rece ive a wound or a burn, your body mobilizes its repair squad to make good the damage . Infection by bacteria hinder s the repair squad in its work and may even overwhelm it, so that the wound heals slowly or not at all.

some of the older antiseptics do quite effectively.

B.T.C. (Railways and Docks) MEN Afarks 1. Exmouth Junction M .P. No.1 495t (winning the Challenge Shield) 2. Bristol D.O.S.O. 479 (winning the Corbet Fletcher Cup) 3. Derby M. &E. E. Erecting Shop 47St 4. Horsham No.1 471 5. Camden Goods 461 t 6. King's Cross M.P. 460 7. Swindon' B ' 451 8. Worksop 444 9. Bridgeton 414 10. Lots Road 404 11 . Newcastle Central 401 12. Dewsbury Central 384.} 13. Edinburgh (Waverley) 337WOMEN l. Eastleigh Accounts (winning the Burrows Bowl) 2. Marylebone No.1 3. Hull D.S.O. } Tied 4. Baker Street 5. Glasgow ... 6. Horwich Accounts 7. Newton Abbott ... 1. 2.

3. 4. 5. 6.

Rose

But no antis eptic , however e ffi c ient, will heal a wound; only the r epair squad can do that. The drawback of th e older antisep tics, such as acriflavin e, tincture of iodine, propamidine, etc., is that th e), interfer e with the r epair squad's activities -

and thus tb emselYes slow -down the process of

h ealing. , Furacin " how ever, is an entirely ne',,' typ e of aerm icide which des troys ba ct eria and prevents

inFection outstandingly well , and ye t leaves the

Afarks 423!

r epair squad unharmed to get on w it h healing the ·w ound.

398 394 384t 361-1 324

For this r eason, 'Furacin' is becoming m or e and more wid ely us ed in hospitals and first-aid ro oms in this country and America. Made up

B.T.e. POLICE Afarks Liverpool Street 'A ' 408 (winning the Sir Bertram Ford Challenge Shield) Preston ... 4061 (winning the Chiefs of Police Cup) Dover 387 Darlington 373t Edinburgh 369f Parkes ton Quay 345t

In responding to the invitation of the Director-General to present the trophies Sir Brian Robertson commenced by expressing the keen pleasure both he and Lady Robertson had experienced in accepting the invitation to attend that afternoon. He had seen some of the trials and had been greatly impressed with the staging which provided the realism so necessary to their training. He had always taken a great interest in the ambulance movement, although, at the moment, he believed that he was not in need of any treatment himself.

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FIRST AID & NURSING, JULYA/UGUST 1955

FIRST AID & NURSING, JULY/AUGUST 1955

• the audience From a seat In Some random (and provocative) comments on the competitions S.J.A.B. Finals Don't first-aiders known how to fiJl ho t-water bottles ? , Gently' doesn 't necessarily mean ' dead slow.' Much time is often wasted needlessly. Some were more concerned about the fractured patell a than the general condition of the patient. , Nuisances' a re val uable, but they were not always sufficiently obstructive. We could name one or two who are particul arly good at this. Why h unt the place down when the daughter could have directed to a nything required ? She only needed to be asked. Sylvester appears to have been almost forgotten by some. It still has its uses. G rip tbe elbow, not the wrists. Sylvester is useless if no pressure is exerted on the chest. Leaders MU ST learn to lead. All judges did no t inspect the bandaging afterwards. Some deputed the policem an to take ch arge of the' nui sance ' -good. Poor P.c. Argyle ! In trouble again ! D id they mistake him for the Teddy boy ? You cannot take the pulse with your thumb ! ' Switch off the lights.' Did he realise that he would then be working-in the dark ? Bedmaking-Nurses MUST keep together. We don't like to see both nurses on the same side withou t some special reason . There is a special technique for assisting patient from chair to bed. Ask your N .O. to teach you. , Don't you drop him.' The apprehension was justified. Turning patien t was not always carried out as gently as might have been desired. It was fortunate that the stretcher with two in verted chairs was not to be loa ded into the top berth. You can't take P and R without a watch. Why not totally submerge the burned hand ? The bowl was large enough. How could he examine the pupils of a patient in the prone position ? Do be explicit in giving instructions to non-fust-aiders. We were informed by the judge in response to our question that only half the teams discovered the aspirins, although fully exposed to view on th e table. ' Observant' is the first qu alification. Technique of turning patient needs attention. 'Patient conunencing to breathe ' don 't discontinue A.R. The noisy team test at the other end of the room proved very distracting to compet itors in the women's indi vidual tests. Washing hai r- Make certain head of patient is a bove level of side of bed otherwise a pool of wateI will result. ' DO.n' t stand on one leg whilst attending a pati ent. . Make certa in that your tray or trolley IS complete-even to a comb ! In trea tin~ fr~ctured clavicle, padding ~nder arm-pIts Wlll prevent bandage cutting mto flesh.

Surely nerve shock should be treated before a fracture. How many asked the temperature of the room ?

Trained 'patients ' are often able to furnish valuable hints as a result of their experiences. Miss Marsh, an experienced , patient ' drew our attention to the practice of many competitors, when examining the pupils, of forcibly separating the upper and lower borders of the orbit with finger and thumb. This is not only painful but unnecessary. Mrs. Thompson, another trained 'patient,' states that many, in palpating for fracture of the upper limb, wilt persist in fully abducting the limb, often beyond normal limits. This is not only painful, but may possibly increase the damage already existing. We are grateful to these trained ' patients' for these notes on their experience.

S.J.A.B. Cadets Take care to finger sterile dressings as little as possible. The kitchen had been wrecked by the explosion, but a row of crockery remained intact on a dresser shelf ! Hands should be washed BEFORE applying dressing, not after. Why apply a barrel bandage for bumt face ? What is the temperature of an empty hot-water bottle? , Any neighbours ?' This was a good point. Some competitors returned to the gasfilled room without a mask. There was rather too much manipulation in the case of the fractured clavicle. Some treated the mother before the boy. , Discriminating ' is the sixth qualification. , Your ambulance has arrived ' somewhat startled some of these young competitors. Every member tested the stretcher. Was this not rather overdoing it ? The meticulously careful bandaging by the juniors was most conunendable. Traction on limb must be more than a mere gesture. These muscles are very powerful. Fanning should be carried out with long sweeps. Little flicks create practically no draught. It is useless trying to squeeze in padding after the limb has been splinted. How could that poor little kid remember all that ? Mr. Argyle must by now be an expert in pulling down doors ! . We are pleased to see the Cadets being trained as • patients.' Watch them , C.u. In fractured clavicle the two main classical signs are often overlooked. Bedmalcing by juniors was excellent. 'Would you like a book to read?' This was most thoughtful. Use the forceps when available, not fingers. You will never shake that thermometer down if you hold it too stiffly. Practice with an orange stick .

B.T.C. and B.T.C. Police Trouser leg is not a substitute for padding. One leader tried to do too much on his own. What is the use of using forceps to hold dressing if you finger it afterwards? Removed patient's spectacles - then placed them in the middle of the roadway! More use could have been made of the policeman- and most policemen are firstaiders. Regional anatomy requires more studywhere is the third lumbar ? No-one asked ' Is the train heated? ' Don't guess the position of the back pad. Measure it. It must be exact. On judge had a short, helpful talk with each team afterwards. We are sure this was much appreciated. Let diagnosis be systematic. To commence at the head is a good plan for often the most serious condition is associated with this region. Why do , you learn the head bandage ? How often it is forgotton. In fractured clavicle shoulders are not drawn back tightly enough. Don't be afraid to stick your knee into his back. It is useless trying to palpate the spine tbrough clothing. Find the cause of unconsciousness first. The dislocation can wait. A screwed-up handkerchief is not a compress. Support to jaw must be continuous. Those barrel bandages would not have supported a flea. For goodness' sake don ' t keep saying , we' re first-aiders .' ' Take a deep breath ' three times. Once would have been sufficient.

Met., City and B.T.C. Policewomen Too much delay in preparing before commencing Holger-Nielsen . Don't be afraid to lift the arm well up. Movements of the two operators did not always synchronize. More thorough knowledge of physiology of respiration indicated. How many can judge accurately the length of a second? . There is always a tendency to progressive increase in speed. Explanation by the three leaders was excellent, especially as they were, obviously, unused to public speaking. It was an unusual test and they tackled it well. Those taps on the back were useless. It must be a hard slap. They were rather rough with the leg, although warned' gently.' All competitors knelt on both knees for H-N. It must be admitted that the regulation position is difficult for women. ' Any F .A. equipment?' Too much reliance is placed upon this. Learn to improvise more. Importance and value of comparison with opposite side is not sufficiently appreciated. ' Pupils unequal.' This should have narrowed down the diagnosis.

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Miscellaneous Advertisements Advertisements with remittance should be sent to First Aid & Nursing, 32 Finsbury Square, London, E.C.2. Rate 4d. per word, minimum 6s. Box numbers 15. extra.

WEST MIDLANDS GAS BOARD Walsall and District Division SURGERY ATTENDANT / First Aid Instructor required by Smethwick Group of Undertakings. Wage 3/l0i d. per hour--44 hour week. Apply .i~ ~riting to the Divisional General Manager, N.3 DIVISIOn, West Midlands Gas Board, Walsall Factory Estate, Tame Bridge, Walsall. UR NEW SERIES of Competition Papers based on 40th Edition S.J.A.B. Book now ready. Team tests five for 5s. Individual tests eight for 5s. Selby & Plowright, 135 Russell Street, Kettering. J.A.B. Car Badges, 30s. S.J.A.B. Badge Wall Shields • 26s. 6d. S.J.A.B. Gold cased crested CuffLinks, 50s. S.J.A.B. Badge Ladies' Brooches, ?ls. Trophy Shiel?s supplied. White' Old En¥land ' shIrts, 2.1s. 6d. ; Poplin quality, 30s. (state collar SIze). Medal nbbons ?d. eac~ on buckram for sewing on uniforms, Is. each nbbon If mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for ' leaflets.-Montague Jeffery, Outfitter, st. Giles Street, Northampton. CENT CARDS, 250 17/6, 1,000 52/6. Tickets, Posters, Memos. Samples free- TrCES, 11 Oaklands Grove, London, W.12.

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FIRST AID & NURSING, JULY/AUGUST 1955

Ileaders~

queries Answered by Dr. A. D. Belilios Wounds with Foreign Body Protruding

L. J. M. (Hove) writes :In the S.J.A.A. Handbook (40th Edition), page 97, we are instructed to 'apply a dressing and build up pads around the wound, to a sufficient height to apply pressure, without pressing on the foreign body.' If blood still soaks through the instructions add that we 'apply further pads and bandages.' Are we to take this instruction to mean that these' further pads' should be built up around the wound, or should they be applied directly on top of the first dressing. Answer

The principle of the instruction is that direct pressure must be avoided over the protruding foreign body because this would tend to force it further inwards and cause further damage. It follows, therefore, that any further pads that are applied should be built up round the wound.

Glandular Fever

E. J. W. (Southampton) writes . I see from the papers that the work of certain London hospitals has been seriously upset by outbreaks of Glandular Fever. I shall be grateful for some information on this ailment. Answer

The disease usually affects young adults and has an incubation period of 5 to 12 days. The patient suffers from headache, sore throat, stiffness of the neck and occasionally a rash. Glands become enlarged in the neck arm-pits, groins and elsewhere. Th~ p~tient may become seriously ill wIth fever; enlarged glands in the chest and abdomen may cause cough and digestive disturbances.

Artificial Respiration

A. D. (Birmingham) writes :_ . A guest instructor visited our first azd class and as a result a difference of opinion arose as to the correct

method of turning a patient over when using the Holger Nielson method of artificial respiration. Would you please give your ruling and oblige. I may add that your contribution to First Aid and Nursing is eagerly read by our class members, while I have maintained a type copy in a scrap book for some time and found it most valuable. QUERY.-Supplement to the 40th Edition, First Aid to the Injured. Page 3.-Turning : , Go down on the right knee opposite the patient's head.' The disagreement centres around the word opposite. Do we read it to mean by the side of the patient, i.e., opposite his face, ear and cheek or body; or as our Divisional Surgeon first demonstrated it, in line with the body at the patient's head, i.e., in a similar position to that finally assumed by the operator. On page 4, the term 'in line' is used and is easily understood, but we find it very difficult to reconcile opposite with our D.S's. interpretation. We have also found that small people cannot turn a heavy patient comfortably unless it is done from the side. Personally, I have followed the doctor's interpretation in class practice, but prefer the Schafer method in case of actual accident. Answer

I agree with the interpretation of your Divisional Surgeon. But naturally the all-important problem is how to turn a patient in an actual emergency, and I do not feel the exact method matters so long as the procedure is carried out expeditiously and safely.

Phenobarbitone Poisoning

A. E. (Rhondda) writes : What are the signs and symptoms of Phenobarbitone poisoning and what first aid treatment should be rendered? What are the signs and symptoms of Aspirin poisoning, and the first aid treatment of the same ? Answer

Phenobarbitone: Increasing drowsiness leading to coma. Pallor and in severe cases, cyanosis. Small pupils, quick and feeble pulse; cold and clammy skin.

Aspirin: Nausea and perhaps vomiting. Singing in the ears and deafness; mental confusion leading to sleepiness and coma. Breathing deep and slow, pulse rate quickened ; swea ting and pallor. First aid-If patient conscious, induce vomiting by emetic or by thrusting finger boldly down throat. Then give two cupfuls of warm water and again thrust finger down throat thus washing out stomach. This procedure can be repeated with advantage and followed by giving drinks of tea or coffee. If unconscious, apply general principles and be prepared to give artificial respiration and oxygen liberally. In all cases, obtain medical advice as quickly as possible and apply the general principles.

Piles

J. A. B. (Bournemouth) writes I am in charge of the first aid room of a factory and am often asked by workers to recommend a treatment for piles. I am afraid I knolV very little about them, and should be grateful for some ideas as to what I should advise. Answer

Piles or haemorrhoids are varicose veins in the region of the rectum. They occur in various degrees of severity, sometimes being accompanied by bleeding and sometimes with protrusion. They are not within the scope of first aid either for diagnosis or treatment and it is essential that you should withhold ad vice except to recommend a doctor.

Infantile Paralysis

E. C. M. (Nottingham) writes I have been watching with interest the newspaper reports dealing with prevention of Infantile Paralysis. I should be very grateful if Dr. Belilios could briefly tell us the cause of the complaint and explain the method of prevention that is being tried out. Answer

Infantile Paralysis or Poliomyelitis is caused by a virus of which three types have so far been identified; there may be more. Most big epidemics are caused by type 1, but immunity to one type does not protect against infection from others.

FIR ST AID & NURSING, JULY/AUGUST 1955

A vaccine has been made containing all three types and is given by three intramuscular injections at appropriate intervals. The newspaper reports suggest that' weaning' difficulties are being experienced in America but the principle is sound and, although a cautious judgment must always be preserved when considering any new method, the outlook for the prevention of ' polio' seems promising.

* First-Aiders Crossword No. 18 Compiled by W. A. Potter

Polythene Splints Polythene in combination with Moltopren (polyurethane foam) is n,?w being ext.ensively used in the making of medical splints as the result of research undertaken at the Plastics Research Unit of the Royal ationa! Orthopaedic Hospital, Stanmore, and at King's College, London. The splint is made by taking an appropriately tailored sheet of polythene t in. or -fs in. thick, with the necessary reinforcing strips and placing them on a similarly shaped sheet of k in. thick Moltopren. The two materials are then placed on the floor of an infra-red oven, specially developed for the purpose by the General Electric Company, with the polythene uppermost. When the polythene melts and becomes transparent , it fuses with ~he Moltopren which, being a thermo~ettu:g material is unaffected by the rise ill temperature of the polythene to 130 °C. A sheet.of stockinet is then stretched over the softened polythene-Moltopren laminate which is then removed from the oven and applied to the plaster cast. The laminate is moulded by stretching the stockinet around the cast. Small ann and leg splints can, it is claimed, be moulded directly on the pati~nt if required, since the Moltop~en WhiCh fonns the part of the laminate m contact with the skin has an especially low thermal conductivity. The polythene - Moltopren moulding may be re-softened in the oven and then remoulded if necessary. The finished splint is held in place b~ buckles and straps which are rIveted mto the hardened plastic. Resignation of Society's President Sir Charles Bartlett has tendered his resignation from the post of Presid.ent of the Royal Society for the PreventIon of Accidents. The Society has accepted the resignatio.n with the utmost regret, particularly as SIT Charles intimated that his action was due to continued indisposition and was taken on the advice of his doctors. A fonner Chainnan and Managing Director of Vauxhall Motors Ltd ., Sir Charles was elected President in October, 1953, in succession to Lord Llewellin, who relinquished the office when he was appotnted Governor-General of the Central African Federation.

ACROSS 9. Life processes at rest (5, 10) 10. Rip the middle of a cow's stomach for food ... (5) (3) 11. Incombustible wood? 12. Record the onset this way (5) 13. Rash place to treat fractures? On the contrary! ... .., (2,3,4) 15. Animals assess a lost shilling... (5) 17. Return of disease in conva(7) lescence 19. Replaces in anatomically normal position (7) 21. Talk senselessly (5) 24. The first-aider unlike Ethelred (4,5) 28. Vehicle in oatmeal or rye (5) 29. Hunger of severe haemorrhage (3) 30. An ulcer may so appear (5) 31. Carry hope! D irt is variable as a cause of many epidemics ... (7,8)

DOW:\ 1. A deadly place for animals 2. Stupid fellow beginning to help 3. Remove from uninjured an::n first ... 4. D .P. came in confusion to depart hurriedly 5. May be necessary when normal micturition fails .. . . .. 6. Grain in part of the eye 7. Anatomical opening ... 8. Vomiting 14. Organ which upsets the earth ... 16. Fomentation ... 18. Red meals become green 20. Telescope for espionage? 21. Friend conswned in the mouth 22. Rough pat and rub together ... 23. Origin of a word ... 25. Cerumen 26. Patient's medical history 27. Evil prophylactic

(8)

(6) (6) (6) (8) (6) (6) (6) (5) (5)

(8)

(3,5) (6) (6) (6)

(3,3) (6) (6)

SOLUTION TO CROSSWORD No. 17 ACR OSS 1 Universal donor; 8, enforce; .10, pigtail; 11, rare; 1~, tepid; 13, disc: 16, estrogen; 17, stings; 19, maggot: 21, disorder; 24, tone; 25, aI?ode: 26, Etna; 29, sultana; 30, painful, 32, patella reflex.

DOWN 1, Use; 2, infarct.; 3, ears; 4, lipoi.d ; 5, orgy ; 6, ovanan ; 7, glycosuna: 9, eyelet; 11 , rheumatIsm; 14, mot<;,r : 15, stool; 18, wind up; 20, gangl1a, 22, dutiful ; 23, on call; 27, case; 28, bite; 31, lax.

FIRST AID & NURSING, JULY/AUGUST 1955

FIRST AID & NURSING, JULY/AUGUST 1955 "

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- - ' - '-

Shows the top stretcher lo wered ready for loading.

C. Illustra tes t he same Gear with t h e top stretcher frame hi nged down for use when only one stretcher case is carried. D. Shows the same position as in " c' only with cushions and back rest fitted for convalescent cases.

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

"\- .

~:# I

" ~.

PATENT

Edited by A. P. GORHAM, M.B., Ch.B., M.R.C.S. Police Surgeon, City and County of Bristol

First Aid Requisites

·causu

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September / October 1955

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THANKS for their voluntary wo~ k, and an appeal for more recrUlts, were chief points in an address by Lieut.-General Sir Otto Lund, Commissioner-in-Chief, St. John Ambulance Brigade, when he attended a parade of St. Jo hn Ambulance Brigade personnel at Weston-superMare rugby ground, recently. Over 2,000 members from 90 Somerset detachments were on parade, which was reviewed and inspected by Sir Otto. He was accompanied by Lord Hylton, Lord Lieutenant of the county and county president of the Brigade, Mrs . Geoffrey Luttrell, of Dunster Castle, lady county president, and Miss E. M~ Bruce-Steer, of Minehead,

lady county superintendent. The parade was commanded by Colonel C. T . Mitford-Slade, of Norton Fitzwarren, County Commissioner. The parade was held in warm sunshine, and the black, white and grey uniforms of the men, women and cadets made a striking and most unusual, picture on the rugby field. The two stands were packed with spectators, wh o were entertained by No . 5 Regional Band, R.A .F ., Locking, which played selections during the review. Among those present were the Mayor and Mayoress of Weston (Councillor and Mrs . R . Ivens), the T own Clerk (Mr. R . G. Lickford), and Mrs . Lickford .

(Top) General view of the parade. (Bottom) L t. /Gen. Sir Otto L und, Co~ miss ioner in-Chief, has a few words of congratulation for Supt. B. G. RuddIck, of the Norton-Radstock lJi vision during his tour of inspection.

In this Issue 2,000 on Parade Glass with Care

Ministry of Supply Finals

Di sa ster Relief

Acute Abdominal Pain Atomic E nergy Authority Competitions

B.R.C.S. Annual Report

News and Notes

Readers' Queries

First-aider's Crossword

Regulation Uniform for

2~OOO

Do you know that • •• 1. In asphyxia breathing ceases approximately five minutes before the heart stops beating ? 2. There are 750 millions of air sacs (a lveoli) in the lungs of a normal adult ? 3. Gas gangrene was fir~t recog~ized by the French surgeon AmbrOIse Par e (15091590) ? 4. The venom from wasp stings is alkaline in reaction and should be tre~ted with an acid antidote, wher~as !hat from bees and other British insects IS aCid (.mostly formic) and should he treated WIth an alkaHne antidote ? 5. The normal skin sets. up a mild antiseptic action due, poss ~IY, to the presence of certain fatty acids . 6. A woman requires onl y four-fifths the calories required by a man ?

FlRST AID &

URSI G, SEPTEMBER OCTOBER 1955

Glass with Care by M. A. Stableford of the Glass Manufacturers' Federation A study of the problems and achievements in first aid and nursing in a glass factory.

A VISIT to a large glass factory in a pleasant rural suburb of London shows how carefully planned preventive measures can curb man's natural tendencies to be careless. This factory, which produces large quantities of bottles and jars each year, actually had the lowest accident frequency rate for the glass container industry for the year 1952. It was only 0.89 per 100,000 man hours. For the year 1954 it was 0.84 which is again expected to be the lowest for the industry. This seems a great achievement when one visits the workshops where molten glass is automatically blown or pressed at an amazing rate to make bottles and jars of all kinds. Production is so mechanized that the few men one sees seem to be lost amidst highly complicated machinery. In fact, however, this factory employs over twelve hundred people, mostly working on 8-hour shifts. It is interesting to note that during the war when 12-hour shifts were worked, accidents usually happened at the end of the shift. With the return to shorter periods of work however, less accidents take place at the end of the shift. Employee Education One of the best ways to prevent such accidents is, of course to interest the employees in this se;ious problem. An Accident Prevention Committee which is composed partly of the management, and partly of employees nominated by the shop stewards drawn from the various trade unions involved, meets once a month to ?iscuss all recent injuries, however slight, which have occurred. This Committee is fortunate in having as its safety officer a senior man who is able to visit workers who have been suffering from a series of minor accidents. Often a talk with the officer will reveal the cause of such accidents; a family worry, or even the fact that a new baby is expected in the family may often result in lack of concentration.

Members of the Committee visit the scene of the accident immediately, and new precautions are put into effect where necessary. Plastic-soled Shoe Often such accidents would never have happened if the right kind of safety clothing had been worn. A new type of plastic-soled shoe with a steel toe-cap has been found very successful as a protection against foot injuries and slipping if floors are oily. Special goggles and eye-shields are provided for furnace man and other workers where required, donkey coats for those working outside in winter, and special aprons for cratehandlers. The cap, which used to be a traditional part of the British workman's dress, has unfortunately become less popUlar. It it were worn more often, there would be less accidents resulting from small pieces of glass or coal falling from overhead conveyor systems. Women labelling bottles by a silk-screening process, are issued with specially designed caps to protect the hair from the paint. Production at this factory is continuous, and the Medical Centre is

always ready to deal with casualties. A skilled Sister working under a qualified doctor, is in charge of this centre, assisted by four medical orderlies. In a well-equipped surgery she is able to deal with all minor injuries. Her deft touch in removing small foreign bodies from eyes is now much appreciated by the workers, although in common with most departments of this kind, there was some initial prejudice to overcome in pre-war days. Now even the' toughest' worker comes straight to the Medical Centre for treatment, even where the injury is very slight. The Doctor examines new employees, and the job of deciding into which department they are most suited to enter is an interesting one. A new Sun Ray Lamp recently installed has given good results in various treatments prescribed by employees' private doctors. Wheel Trolley When a serious accident occurs the Sister is able to be on-the-spot within a very few minutes, thanks to an excellent internal telephone system. A wheel trolley has recently been substituted for the stretcher

The glass factory's first aid department

FIRST AID &

URSI 'G, SEPTEMBER OCTOBER 1955

previously used. a.nd it is foun~ to be quicker and eaSIer to use Il1 the negotiation of machinery. A kit containing large and small dressings, antiseptic, and smelling salts, and also a wheel chair, are always ready to be rushed out into any part of the factory . There is a car service to a hospital nearby. Accident-Conscious It is interesting to realise what a lot can be done by the training of

employees in accident prevention . In time, it is hoped to make all workers 'accident-conscious,' and several posters using a minimum of wording are displayed at key points within the factory. Colour can also play a most important part in this difficult task. Pipelines are now being distinguished by the application of gay and cheerful paint. All electric supplies are now painted a bright orange, for example fork trucks are a lively yellow.

There is still a need for psychologists. lighting engineers and architects to meet all the requirements of those who are interested in first aid and accident prevention. One feels, even when visiting the most modern factory , that this science is still in its early stages. Accidents are a grim subject, but the result of the work of Prevention Committees is a cheering one.

Ministry of Supply Finals 'A DAY in the Life of a Competition

Secretary.' If only that energetic and experienced organizer, Mr. George Craft could be induced to write his mem~irs, what an interesting volum~ he could produce. He must know every lllch of the Porchester Halls. Bayswater and the Central Hall Westminster. It was at the latter that th~ 1inistry of SuppLy ationaL First Aid Competitions were heLd under the auspices of the St. John Ambulance Association, when 12 men's teams and 5 women's teams competed for the Challenge Trophies presented by the Association. Again the tests for both men and women proved of a most interesting character. In the team test for men, which was set and judged by Dr. K. P. Duncan. of Bristol, the members came across a cyclist lying in the road, with his cycle on top of him. Apparently he had ridden on a jagged piece of glass, causing a tear in the front tyre. Examination revealed a large bruIse on forehead, concussion, compound fract!Jre of left tibia simple fracture of left davlcle and small 'c uts on left hand with slight bleeding. In the women's team test the members are approaching the home of a friend when the mother rushes out and informs them that her daughter has met with an accident. They find her at the foot of the stairs, having hurt her back in the fall. The injuries are suspected fracture of the splOe, compound fracture of left radius, wound in left palm and shock. The test was set and judged by Dr. C. M. H. Rotman, of Watford. In tbe men's dual practical tests os. 1 and 2 are called to a carpenter's shop where they find a man who, whilst chiselling a piece of wood, had fallen to the ground with a cry, causing a severe incise~ wound of the right upper aIm, severlOg the brachial artery. He is also suffering from epilepsy. os. 3 and 4 fi!ld a~ e.l derly lady lying on the ground, With palO III her right leg. Examination reveals fractured neck of femur and toxic shock. These two tests were set and judged by Dr. J. A. Hanraty, of Deal. In the women's dual practical tests, which were set and judged by Dr. J. H. Dixon, of Braintree, os. 1 and 2 are called to the basement of a theatre, where they find an electrician lying on the floor and holding a wire which has draped

itself over an iron-clad mainswitch. He is suffering from asphyxia and burns in right palm. He recovers consciousness two minutes after commencement of A.R., provided it is properly performed. The test for os. 3 . tnd 4 is also set in a basement, this time of an old-fashioned store, where they bear a commotion near the lift. They find that a man haS falLen down the lift-shaft and now lies behind the trellis gate of the lift. lnjuries prove to be simple fracture of right tibia , right Colle<;' fracture and shock. Most of the tests had been set with a view to testing the ingenuity as well as the first aid skill of the competitors. At the Presentation Ceremony the chair was occupied by Mr. Horace F. Parshall , T.D., M.A. (Oxon), Director-General of the St. John Ambulance Association , who was supported by Sir James Helmore, K.C.B., K .C.M.G. , Permanent Secretary. Ministry of Supply: Mr. J . B. ~ . .Munro , C.M.G .. Chairman of the MInIstry of Supply Ambulance Centre; Mr. ~aliol Scott ; Mr. R . Burns; Col. A. \. G. Dower, President of the Oxfordshire Centre, and the judges. In opening the proceedings, My. Parshall said' It is a great pleasure to me to extend a welcome to Sir James Helmore. who has honoured llS by coming here to present the trophies." He also wished to welcome tbe other guests from the Brigade and other organizations engaged in ambulance work, for there is a great deal to be learned from tbese competitions, and especially from the mistakes made by others. Dr. Duncan, in response to tbe Chairman's invitation, then comment~d upon the work he had seen that day. FIrst of all great care should be e 'ercised in examining the eye. They must remember that they are dealing with a very delicate organ, an~ one which could very easily be damaged If not handled carefully. In sending messages to doctor, ambulance or police be definite and say exactly where you want them. He had known of cases in which these people had been sent many miles out of their way simply because the messages had n,?t been sufficiently cleaT. Mrs. Beeton, In her well-known cookery book, used the phrase , First catch your hare.' They, also, must do things in the right order. They must first diagnose the case, for no treatment can be carried out before the case has ~een properly diagnosed, and, above all thlOgS,

the patient must not be moved before this had been completed. They must not assume tbat bystanders are first-aiders, and they must. therefore, always explain fully exactly what they", ant a bystander to do. Dr. Dixon followed, and said that he thought the ladies had acquitted themselves well. Tbe Ministry of Supply should be congratulated upon having them. He admitted that the two dual tests were really more suitable for men, but the ladies had done well. All. without exception, had immediately switched off the current, but only one had noticed that the switch was live, being in contact with the cable. All bad realized immediately that artificial respiration was indicated, but he warned them always to make certain that the spine was not mjured before performing this operation. He had noticed the difference between the teams in the performance of artificial respiration. Only one competitor had washed or sterilised her hands before ot all had removed the treating the burns. patient \\ithout delay, realising [hat tne lift might have descended at any m0f!1~nl. Besides this he was in a cramped pOSItiOn. They should. have steadied .the limb as well as possible and dragged hlm. ~)Ut at once. The results of the Competitions were as follows : 1£,-: (Afaxillllll11 marks obtainable-400) Marks I . A.R.D.E., Fort Halstead 320 (winning the S.J.A.A. Challenge Trophy) . 2. R.O.F., Bishopton 313 3. S.D., Elstow 307 4. H.Q. , Chessington 303 5. R.A .E. , Farnborough 301 6. R.R .E ., Defford 300 7 R .O .F., Uanishen 298}, C.D.E.E., Porton 2799. R .O.F., Swynnerton 276 to R.O .F. , F azakerley 259 R.O .F. , Birtley 244 12. R .O .F., Blackburn ... :.. 206 Winners of the men's dual practlcal test: os. 3 and 4, R.R.E., Defford. WOMEN l\1arks I. S.D ., Elstow ... .., ... 271 (winning the SJ .A.A. Challenge Trophy) 2. H.Q., St. Giles Court ... 248 3. R.A.U., Hereford 217 4. R.O.F., Wigan ... 216 5. R .O.F., Blackburn .. , ... 29 5 Winners of [he women's dual practical test: os. 1 and 2, R.O.F. , Wigan.

11:

FIRST AID &

URSI G, SEPTEMBER OCTOBER 1955

BARNETT DILL CONFERENCE ON

DISASTER RELIEF and the part to be played by the Britisll Red Cross Society Reported by F. C. Reeve, F.Z.S., F.R.E.S., Hon. F.I.C.A.P. forty years have passed N EARLY since the destruction of a large powder works in Kent by an explosion which resulted in the death of 105 victims and many scores of injured. I was called from hospital and travelled, together with the M.O. of the hospital, some 15 miles to the site of the disaster, where we were confronted with a scene of confusion which I shall never forget. No-one considered it his duty to take charge of the hundreds of people who had gathered to render help, and it was impossible to distinguish trained helpers from untrained, except in the case of some nurses who had been recruited from local hospitals and myself-I was still in the white coat I was wearing when called from hospital. The late World War resulted in the creation of a scheme for organizing and coordinating the various civil forces to deal with catastrophes which might occur as a result of a blitz, but this organization, excellent as it is for this purpose, where incidents are more or less anticipated, is entirely unsuitable for dealing with peacetime emergencies like the East Coast floods, the Farnborough Air Display, railway disasters and fires, which occur without warning. This fact has long been realised by MajorGeneral L. A. Hawes, C.B.E., D.S.O., M.e., M.A., Controller, Home Department, British Red Cross Society, who, for many months past, has been working out a scheme which would avoid confusion and wastage such as that which occurred in the disaster referred to in the opening sentences of this Report. At a Conference of Assistant County Directors held at Barnett Hill, the well-known B.R.C.S. Training Centre in Surrey, during the week-end 25th-26th June, which I was privileged to attend as the guest of Major-General Hawes, he explained the emergency scheme which

he had so thoroughly worked out. The first session was devoted to a lecture, in which he described in detail this plan of operation which could be called to life almost at a moment's notice. Although I had made copious notes during the lecture, those which he himself supplied to me afterwards formed so complete a synopsis of the lecture that I can do no better than use them more or less verbatim, with very little editing, as the basis of this report. In opening the lecture General Hawes emphasized the importance of a full appreciation of the conditions which usually prevail in an emergency, and these he tabulated as :(a) The situation is uncertain; even if its general character has been foreseen; (b) There are usually many rumours; (c) There is often exaggeration of the casualties and of the degree of the disaster ; (d) Events near at hand are easily recognized and tend to monopolize attention, whilst conditions in more remote areas are unknown until much later and tend to be neglected ; (e) Urgent tasks to be carried out include rescue work, first aid and prevention of further damage by floods, fire, etc. ; (f) Long term tasks include rehabilitation, repairs and the safeguarding of health, supplies, etc. ; (g) There may be temporary shortages of food, clothing and equipment, including medical supplies, and labour; (h) Telephone and other communications may be disrupted, making the task of finding out the situation more difficult ; (i) Those in control may become casualties or themselves be involved in the disaster ;

(j) Transport arrangements may be dislocated because the vehicles normally available may have been destroyed or marooned. The situation may be further complicated by disrupted communications ; (k) Abnormal tasks may have to be undertaken. For example, the handling of 100,000 cases of clothing by the Somerset Branch after the Lynmouth floods. As a result shortage of labour is probable; (I) There are often heavy casualties entailing unusual demands for doctors, nurses and medical stores; (m) There are often casualties to houses, necessitating emergency housing measures ; (n) Some areas are normally immune from certain types of probable disaster, e.g., houses on high ground in areas where floods are likely; (0) Reinforcements from unaffected areas are likely to arrive and to require housing and feeding; (p) Past experience has taught that numbers of well-meaning helpers come into the area, and, unless organized, their efforts are largely ineffective, and they may even be an embarrassment.

The lecturer went on to point out that the training of members of the British Red Cross Society was a specialized one, and, although he was first of all taking a general survey of the whole situation, and dealing with the functions of the various bodies who would be concerned in helping at an emergency, he proposed a little later in the lecture to emphasize the very important part which would be played by members as a result of their specialized training. In the meantime he continued to survey the situation as a whole, summing up

FIRST AID &

URSI TG, SEPTEMBER /OCTOBER 1955

the general principles upon which action by all concerned should bg based :(A) Information should have been collected before the disaster for the framing of an emergency plan,. ~nd when the disaster occurs, for gIvmg effect to the plan. This information, which must be as complete as possible, should cover :(1) The scope and cours~ of the possible disasters. SpeCIal attention should be paid to possible danger points; (2) Areas to be avoided and safe areas in which headquarters, reserves, etc., can be located; (3) The possible situation of neighbouring areas who might give, or. in their turn, require help ; (4) Available sources of food, equipment (including medical stores), labour, transport available and degree of availability. (B) Using the available .information, a provisional plan IS made, bearing in mind :(1) Relatively small measures, quickly applied, are more effective than to wait for an elaborate operation which may be slow in development. Special emphasis should be laid on the action of individuals immediately in touch with the situation ; (2) To obtain the personnel, equipment and stores for immediate measures reliance should be placed upon those most likely to be available. (3) As soon as immediate action is under way, the full strength of available sources should be mobilized. (4) From the outset a manned Report Centre should be est~b lished at which informatIOn should be collected and collated. On this information plans are developed. (5) People at the scene of the disaster are usually much too occupied to be continually answering the telephone.. .. (6) If a plan is to be effectIve It IS nearly always necessary to. send out in cars or other smtable vehicles, e.g., boats, responsible individuals to find out exactly what is happening. The officer in charge of the operation should himself survey the area at the earliest opportunity. By do!ng so he will get a bird's eye VIew of the scene and be better able

to dispose of reinforcements as they arrive. (7) The plan must be flexible and easy to modify as the situation changes. The General then came to the actual pro blem with which the members of the British Red Cross Society would have to deal, and this he analysed and summarized under the following heads : (a) The Society is primarily concerned with sick, wounded and infirm, their rescue and ca~e. There are other voluntary bodIes who normally deal with fit people. In the early stages of disaster it will usually be the case that all those dealing with it take over whatever action is required, irrespective of their particular responsibilities. When the situation "becomes clearer, and as reinforcements arrive, it is then advisable to revert to accepted activities. If confusion is to be a voided as much prearrangement as is possible should be agreed upon. (b) The Society should have detachments and associate groups right through every county and so should be well placed to take emergency action. This dispersion means that local contacts are universal and intimate. For major operations, however, this dispersion may cause some delay and difficulty. This factor should be borne in mind as plans are laid. The fact that the components of the Society are dispersed means that it is peculiarly well suited to follow up actions, e.g., in the 1947 floods, when 47,000 houses were visited to assess the extent of losses. (c) Plans should provide for immediate action by those in contact with the ircident, of whatever rank. (d) From the nature of things, stores both general and medical, will ~ever be plentiful. Plans should be framed with this fact and with the need for economy in their use, borne in mind. . The lecturer then went on to dIScuss general considerations when framing B.R.e.S. plans. These, also, he tabulated as follows :(a) The key to successful. disaster relief is to decentralize. T~e detachment should be the baSIC

unit. Training and organization for disaster relief should be its first task.' This would include first aid and nursing. (b) The Society is ancillary to the statutory services, Steps should be taken to find out exactly what they will do, and what they would like the Society to do. When plans have been made, then all concerned, the statutory authorities and other voluntary bodies as well as members Of the Society, should have copies of them. To be of maximum value these copies must be kept up to date. (c) Plans should provide for immediate action by detachments, and for means of passing information back so that the resources of the whole Branch can be brought into play. (d) If the Civil Defence Corps or the N.H.S.R., acting as a corporate body, is to undertake action it will be necessary to find out who of the Branch members enrolled in the Corps or Reserve will be available for Branch work. This will avoid any overlapping. (e) Plans should include the withdrawing of detachments as soon as statutory bodies take over, or the need for their presence ceases. The thoroughness and precision of the trained soldier was well seen in the masterly planning of this revolutionary scheme, for not a single asp.ect had been overlooked. The questIOn of finance was next tackled by the lecturer, and he drew attention to the following principles :(a) Funds are available a.t Headquarters for emergenCieS, e.g., for the purchase of gumboots, cleaning materials and other emergency stores, for the use of the Society and other yolunta~y bodies. The W.V.S. IS not III possession of similar funds. This point is a useful. one wh,en arranging co-operatIOn WIth them. (b) Headquarters will alw~ys s~p port Branches and Vo?ll relmburse major expendIture on disaster relief. It is considered that minor expenditure should be met from Branch funds as this is one of the purposes for which they are collected.

FIRST ATD & NURSTNG, SEPTEMBER 'OCTOBER 1955

It is unwise to tie up money 111 large stocks of clothing and equipment, particularly those types which are likely to deteriorate. It is better to arrange bulk purchases from local firms in case of need, and to ear-mark vehicles which will be lent, or can be hired, when necessary. (d) Headquarters will provide representatives to serve on central fund-raising bodies, and will arrange for local representatives to serve on local committees at all levels. It is important that such opportunities should be taken up. Dealing with the question of welfare in a Branch plan he makes these points :Care must be taken to avoid overhipping. This can best be as~ured by making use of normal machmery amI by deciding in advance types of work which are to be undertaken by each of those interested. This can be achieved, either by allotting types of work or areas of activity. In the latter cases, welfare cases found would be retained or passed on to the appropriate body. Welfare cases already being handled by the Society should be visited automatically. All cases dealt with , however small, should always be followed up. It is the responsibility of the Police to trace missing persons. The Branch should, however, offer its help because it is intimately concerned where foreign nationals and their relatives are involved. Implicit in this problem is the recording of the names , addresses and destination of all individuals carried in B.R.C.S. transport. The distribution of overseas gifts should be made by members of the Society, or under their direct supervision. Before concluding his lecture, General Hawes furnished some hints to the emergency squads formed from a detachment for disaster relief. These should be organized from detachments whose situation and strength were suitable. He pointed out that the Police in particular, the N.F.S., the Ambulance Service and Coastguard Service usually receive the first information of a disaster. Plans should be discussed with these bodies whose help should be sought. Telephone numbers and plans should be ex(c)

changed, and these details kept up to date. Contacts should be m':l-d.e with these bodies at Branch, DIVIsional and Detachment level. Members of emergency detachments might be in plain clothes when reporting for duty, and they might, whether in uniform or plain clothes, experience difficu1ty in getting through the Police cordons. To obviate such possibilities a Police pass should be obtained which would be carried in the equipment haversack and taken to the scene of ac60n. He showed a specimen pass which had been used successfully, and it is reproduced here :, ....... .... ... .. ........ ' Constabulary. This is to certify that.. ... .... ............ .. . is a member of an emergency detachment of the British Red Cross Society and should be given access to any accident at which the services of a member of the British Red Cross Society would be of assistance. An alternative or additional safeguard would be the provision of an armlet bearing the badge of the Society for use by members when in plain clothes. General Hawes concluded his lecture by str~ssing the importance of immediate action, and the immediate passing back of information as to :(a) The situation; (b) Action taken; (c) Help required; (d) Who else has been informed. The questions and discussions which followed were striking evidence of the great importance of the scheme, and of its urgency, which was felt by all listeners.

The Demonstrations The second session was devoted to studying the question of training personnel by the use of models. When we entered the lecture hall this time it was to find that the chairs had been re-arranged in a large circle, and on the floor in the centre was an elaborate model of a village of (we were informed) 2,000 inhabitants. I use the word ' elaborate' because this was our first impression, but a closer examination and analysis of the model revealed that the separate units of which it was composed, houses, bungalows, shops (chemist, very important),

cottages, Chlll"ch, village hall, manor house, railway station, hospital, ambulance station, police station, garage, B.R.C.S. road hut, etc., were simply pieces of solid wood cut to shape and painted. The result, however was a most realistic display. It ~as, also, both interesting and significant to learn that these units had been made by members and cadets of the B.R.C.S. People, vehicles (including breakdown lorry), animals, traffic signs, trees, telephone kiosks, etc., were such as could be purchased at any toy shop for a few coppers. This, then, said the lecturer, represented one of the many types of model which could be used by those engaged in training personnel, and others could easily be thought up by the instructors themselves. In this case the village had been located at a cross-roads, and the four roads were represented by wide white tape stretching in all four directions away into the country. The particular incident used at the Conference was the reproduction of an exercise held in a Home County in September 1951. In this exercise it was assumed that a U.S. Air Force transport aircraft with ·a crew of 7 and 45 passengers had crashed into a church at 6 p. m. during a Harvest Festival service. The steeple of the church caught fire (represented by cotton wool painted fire-red) and there were 150 casualties in and around the church. Petrol was scattered over a wide area and most of the casualties were contaminated by it. The General then outlined the plan which has been evolved in one Regional Hospital Board Area for dealing with a major accident, shoyving how information of the accident was transmitted by the Police to the Fire, Ambulance and Hospital Services, and the Voluntary Bodies. . He outlined the tasks each one would undertake, and how they would carry them out. At the conclusion of the discussion on disaster relief the method of using models for teaching a class the technique of dealing with an accident was illustrated. The method demonstrated, details of which are given below, was one suitable for the handling of a relatively small accident. Suitably modified it could be applied to any type of incident.

FTRST AID & NURSING, SEPTEMBER/OCTOBER 1955 (a) After the class has had an opportunity of studying the model, the members should be asked to state who in the locality would be of assistance to them in dealing with crashed aircraft and with a major accident. As each agent is named a card showing his identity should be put down on the house or locality in which he lives. All the normal agents, such as doctors, trained nurses, hospitals, telephone, fire brigade, police, garage, etc., would be of assistance. In addition to R.A.F. stations, Military and Naval headquarters should be contacted when necessary. Having obtained all the agents, they should be dealt with one by one, asking the members of the class to say what each one can do. Two members of the class should be asked, and if there is a disagreement, a third should decide between them. By this means a discussion will be started, the conclusion of which will be remembered. Sometimes it is necessary to guide the class in the right direction by asking judicious questions.

In deciding what action should be taken the first essential is to get . the class to say what their object would be. This should be elicited by question and answer. The importance of a clear definition of the object cannot be over-estimated and it should be pointed out that if the object is not clearly and completely defined results must be ineffective. The object in this case was to prevent the worsening of the condition of casualties, and in more serious cases to save life by giving First Aid, with special reference to the need for getting casualties to hospital with the minimum of delay, and bearing in mind the ever present risk of fire. (b)

(c) The class are then asked. to give all the different factors whIch would influence them in the making of their plan. These are written up on a blackboard. When all relevant questions have been brought out, the class is asked to arrange them in a logical order. For most accidents this order is as given below. 1. Reconnaissance.-(a) Preliminary instructions as to mobilization of available gear to save time; (b) Who wi1l do reconnaissance? ;

mediate first aid action is required, e.g., haemorrhage or shock. 2. Petrol danger.-(a) Whether necessary to remove casualties and then do first aid or vice versa; (b) Instructions re smoking; (c) Control of spectators. 3. Equipment and its uses.-(a) How much available?; (b) How much required?; (c) Where can requirements be found? 4. Allotment of duties.-(a) First aid; (b) Getting help; (c) Traffic control and other duties. 5. First Aid.-(a) Detailed instructions; (b) Who to put in charge; (c) Whether all available members undertake first aid, leaving the task of organization until all casualties have been cared for. All the foregoing factors are concerned with the immediate action which is possible. The factors which follow are concerned with obtaining help and with getting casualties to hospital :-

1. Doctor.-Is one available? 2. Ambulance.-(a) How many required?; (b) Where and how to get them; (c) By what route to approach; (d) Is route obstructed by traffic, floods, etc. 3. Breakdown lorry.-(a) Is one required?; (b) If so, weight to be lifted; (c) By what route? 4. Hospital. - (a) Whether to approach hospital direct; (b) How many beds likely to be required? ; (c) What other information should be given, e.g., blood transfusions, etc. ? 5. Police help.- (a) Whether required; (b) What details to supply. 6. Nearest telephone. 7. Extra help required. 8. Medical comJorts.-(a) Details; (b) Where can they be obtained? (c) Where should tney be delivered? Finally, General Hawes ~howed that details could be studIed by breaking down the processes of the model demonstration, making each the subject of one session, and using larger models, e.g. , plane, loco and coaches, cars and lorries, 'buses, etc., and he gave as examples of these processes :(a) How to do the reconnais~ance and allot members to dutIes. (b) How to handle the petrol situation-whether to move first

and render first aid or vice versa. Control of spectators. (c) Use of equipment. (d) Writing of the message to be sent for help. This process of breaking down can be done (a) on the model; (b) with casualties and service equipment by the class, or (c) as a demonstration by a specially coached team; concluded the lecturer. Major-General Hawes has introduced a new era in the planning of relief in the case of major disasters, and, also, in the preliminary training of personnel. It is to be hoped that no time will be lost by all those concerned in taking up this revolutionary plan seriously, for by so doing many precious lives will be saved and much unnecessary suffering alleviated.

End Piece Red Cross House, Barnett Hill, is the well-known B.R.C.S. Training Centre, situated near the ancient cloth-making village of Wonersh, four miles south of Guildford, in Surrey. It was presented to the British Red Cross Society by Mrs. F. H. Cooke, having been built by her husband in 1906. It was to be used as a hospital ' as long as might be necessary.' With the end of the war its usefulness as a hospital ended, and it was then converted into a Training Centre, where courses, conferences and other gatherings are frequently held. Standing on the summit of Barnett Hill, a high sugar-loaf eminence, it command~ a magnificent view of the surrounding country. Surrounded by 23 acres of beautifully laid-out grounds, it is also a hostel where a most pleasant week-end can be spent in restful seclusion, being capable of accommodating, so I was inform~d by Assistant Commandant MISS Jenner, the charming hostess who welcomed us, from 45 to 50 gue~ts. although she recalled one occaSIOn upon which they managed to cater for seventy for a special training course. The furnishings include many ~ne ~n tiques, many of which have histones attached to them.

FIRST AID & NURSI G, SEPTEMBER OCTOBER 1955

COURSE IN ELEMENTARY FIRST

AID

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

IN these any series of articles such as on first aid which were requested by a number of readers, it is always a good plan to have an interlude now and again and discuss a different subject. This month , therefore, will be devoted to a description of some of the commoner causes of abdominal pain. It is appreciated, of course, that a firstaider must not attempt to treat any of the conditions which wjll be described: his duty is to see that the patient obtains medical advice without undue delay. Nevertheless, he is expected by the public to be a knowledgeable person and this article is intended to increase his general understanding of medical work and hence his value to the community. Appendicitis.-This is a common and important cause of pain in the abdomen. The appendix is a small worm like cul-de-sac which leads off from the first part of the large intestine called the caecum. It is situated in the lower part of the right side of the abdomen. Inflammation caused by germs is the usual cause of appendicitis of which there are three varieties- acute, subacute and chronic. An acute disease begins abruptly and runs a rapid course; a chronic ailment develops gradually and progresses slowly while one which is subacute steers midway in its characteristics between the other two. An acute appendicitis, the most urgent of the types, generally begins with pain in the region of the navel' this pain may be dun and aching i~ character or severe like colic. Its situation changes within the course of hours as it moves downwards and settles in the actual region of the appendix. Other characteristics include a furred tongue, loss of appetite and constipation. The patient's temperature and pulse rate are mode rately raised and will increase as the dis ease progresses. The first-aider can perform a useful purpose in a doubtful case by taking the temperature and

pulse at regular intervals, e.g., hourly and reporting his results to the doctor when he arrives. A specimen of any vOnUt that is not uncommonly produced should be preserved for inspection. There are, of course, other features that will be noted by the medical man and, indeed by a first-aider who has also studied elementary nursing but it is obviously impossible to give a full description in an article of this length. What has occurred is that the appendix has become red, inflamed and swollen perhaps to nearly twice its normal size. Left to itself, it may become gangrenous or perforate, allowing the matter which has formed within it to infect the inside of the abdomen thereby causing an appendix abscess or general peritonitis- both very serious conditions which may prove fatal. These are the reasons why a doctor needs to be called early to an acute appendicitis ; if the diagnosis is confirmed an operation will be advised and the offending organ removed before complications arise. Quick recovery may be. anticipated if the ailment is dealt with in its early stages. General Peritonitis.-This is inflammation of the peritoneum-the delivate covering that lines the inside of the abdomen and also many of the organs such as the stomach and intestines. There are many causes such as appendicitis, perforation of a gastric or duodenal ulcer, penetrating wounds of the abdomen, etc. The early symptoms and signs are those of the causative condition, often combined with those of shock; when, for example, an organ such as the appendix perforates, the temperature may drop to subnormal although the pulse rate remains fast and indeed gradually becomes quicker. The patient complains of severe pain all over his abdomen which, if touched, will be found to be rigid, i.e., stiff. Recurrent vomiting, a rising temperature, a furred tongue and a pinched expression on the face are other characteristics which the doctor takes into COll-

sideration when making his diagnosis. Immediate operation to deal with the cause is the usual treatment followed by injections of penicillin or streptomycin. Colic.-This is not really a disease but a symptom. It is a variety of acute abdominal pain of a spasmodic type. It is the kind of pain which most readers of this article have experienced at some time or other in their lives, perhaps after taking a dose of castor oil or eating unripe apples. It is sharp and stabbing, occurring at frequent intervals and generalized all over the abdomen. Gastro-enteritis.- Inflammation of the stomach and intestines , most particularly their mucous coats, is called gastro-enteritis. It can be due to a variety of causes such as eating bad food , poisoning with certam irritants and infection with germs and viruses. The two latter are of interest in this article, poisoning will be dealt with later in the series. Diseases commonly known as gastric j nftuenza and English dysentery supply examples and although their symptoms and signs somewhat differ, they have certain characteristics in common. They generally begin suddenly with pain in the upper part of the abdomen, often accompanied by vomiting and a raised temperature. Within a short while, the pain descends in the abdomen and becomes of the colicky type. Diarrhoea is a prominent feature and the motions may contain blood. Intestinal obstructiol7.- This is the name given to the condition which occurs when an obstruction arises and prevents the free passage of digested food-stuffs along the intestines. There are many causes such as a growth, adhesions around which the intestines have become kinked, and strangulated hernia. The complaint begins suddenly, the patient complai ns of colic at first felt round the navel. Vomiting soon follows. At first the contents of the stomach are brought up consisting of the last meal. Soon the vomit becomes green In colour

FIRST AID &

URSI TG, SEPTEMBER OCTOBER 1955

because it contains bile while finally it becomes brown with a most unpleasant odour resembling that of motions and therefore called faecal vomiting. The patient is unable to pass flatulence or a motion although there may be a desire to do so. The temperature remains normal or even sub-normal in the early stages but a steadily rising pulse will be noticed. Once again the first-aider can perform a useful purpose by his observation of the patient and all specimens of vomit should be kept for the doctor to see. Strangulated hernia.-A hernia is commonly known as a rupture and takes the form of a swelling under the skin usually in the region of the groin. This swelling is caused by protrusion of some of the contents of the abdomen, which may be intestines or fat , through an aperture in the abdominal wall. The apertures may be in various situations, for example, in the groin, near the naval or in fact in any part of the abdonunal wall in which latter

case the condition is known as a ventral hernia. A hernia itself does not cause acute abdominal pain although it may be uncomfortable but it is liable to develop the complication known as strangulation which occurs when its co·ntents have their blood supply obstructed. This may result from an extra strain such as lifting or coughing, occurring in a patient already suffering from a hernia. In this event an extra coil of intestines may be forced down into the swelling or the intestines may become twisted. Severe pain is noticed in the rupture which soon becomes firm, tender and larger in size. At first there is shock but soon afterwards the characteristics of acute intestinal obstruction make their appearance. A strangulated hernia is included amongst conditions for which first aid can be applied. While. awaiting medical aid, which should be obtained as quickly as possible, the patient should lie on his back with his knees and shoulders raised ; this

position relaxes the abdominal muscles. Repeated cold compresses can be applied to the swelling but nothing must be given by the mouth. Operation will generally be required as an urgent treatment, but some strangulated hernias respond to the repeated application of cold compresses. Renal colic.- Stones or gravel are liable to form in susceptible subjects in the pelvis of the kidney. They may only cause vague symptoms such as occasional pain in the back. Often, however, they are not recognized until the patient develops an attack of renal colic caused through one of the stones attempting to enter the ureter, the little tube which leads from the kidney to the bladder. Renal colic causes intense pain situated in the loin and abdomen over the affected kidney. A characteristic feature is that the pain is referred downwards to the groin of the affected side and even into the upper part of the thigh. Shivering, frequency of micturition and blood in the urine may accompany the attack.

U.K. AtoDlie Enel·gy Authority First Aid Finals THE first ational First Aid Competitions held by the Ambulance Centre of this Au thority since its inception as independent of the Ministry of Supply were held at the Atomic Weapons Research Establishment at AJdermaston under the auspices of the St. John Ambulance Association . Eight teams competed for the trophy which had been provided by the St. John Ambulance Association and another, presented by the Atomic Energy Authority, to be competed for by the ladies' teams. The same tests were set for both men's and women's teams, and consisted of both team and individual (dual) tests.

Team Test: A man had fallen from a ladder sustaining an injury to tongue, fracture of jaw, fracture of right fibula and Colles' fracture (left). He also had apoplexy. Nos. 1 and 3 : These members find a cyclist who has fallen from his machine. Examination reveals a dislocated elbow, a lacerated hand (with grit) and shock. Nos. 2 and 4 : These members are asked to treat a man who has sustained fractured ribs and is also asphyxiated, obviously from a coke fire.

The team test was set and judged by Dr'. H. S. Samuel and the individual practical tests by Dr. Morland. The presentation ceremony was presided over by Brigadier Stone, Co-Ordinator of Technical General Services, who said that they were honoured by the interest and presence of Mr. H orace F. Parshall , T.D., M.A. (Oxon.), Director-General of the St. John Ambulance Association; County Commissioner for Berkshire C. A. Poole, M.A., and County Superintendent for Berkshire the Hon. Mrs. Leslie Gamage. It was unfortunate that the presentation ceremony would have to be curtailed owing to the fact that Mr. Parshall had to leave almost immediately in order to attend another function . Before calling upon him to present the trophies he wished to thank Drs. Samuel and Morland for so readily giving their time and skill to judge the competition tests. Mr. Parshall explained that the po.sition had been somewhat unique. The competition they had witnessed that day w~s not really the first under the new Atorruc Energy Authority, for last year they had organized, certainly in some. haste, a competition, although not a NatIOnal one. The one they were holding that day was, therefore, the first National Competition

under the new Authority. Competiti ons were, undoubtedly, one of the finest ways of learning first aid, but be reminded them that it was just as important to learn what not to do as well as wha t to do in cases of emergency. Success must rest upon the tactful and careful administration of fi rst aid. The results were then announced, and were as follows : 1. Harwell (Ci vil Defence) 'A' t tied { 278 Windscale (Works) .. , J (winning the Challenge Trophy) 3. Aldennaston (Civil Defence) 'A' (ladies) ... .. . ... 249 (winning the A.E.A. Trophy) 4. Aldermaston (Police) 243 5. Aldermaston( Ci vil Defence) 213 6. Harwell (Civil Defence) . B' 196 ] 89 7. Aldermaston (Fire Brigade) 8. Aldermaston (Civil Defence) , B' 186 (ladies) The presentation of the trophies by Mr. Parshall brought to a close this first National First Aid Competition of the United Kingdom Atomic Energy Authority. The winning teams will compete in the St. John Ambulance Association's Competition for the Grand Prior's Trophy on 17th November next at Porchester Hails, London.

FIRST AID & NURST G, SEPTEMBER OCTOBER 1955

FIRST AID &

URSING, SEPTEMBER OCTOBER 1955

British Red Cross Society's Annual Report LYING on the desk before us is the Annual Report for 1954, consisting of 81 pages, made up largely of figures, but the Report, nevertheless, makes interesti ng reading. A few extracts will prove sufficient to show how little is generally known of the activities of this organization. They by no means end with lining the streets on Coronation Day, attending to injuries on the sports ground or serving as auxiliary nurses in our hospitals. Moreover, their activities are not confined to Great Britain despite any impression which may have been created by the title of the Society. Let us first of all glance at that department of the Society's activities which is best known to the general puhlic, first aid. It is staggering to learn that there are 8,223 men, 39,008 women and 42,909 juniors wearing the uniform of the B. R.CS. , denoting that they have received training, confirmed by examination, which renders them capable of administering first aid in cases of accident or sudden illness. Although, as Lord Woollon, Vice-Chairman of the Council, says in his foreword, 1954 did not bring the heavy demands on the Society's first aid, nursing and welfare

services which had been made the previous year, due to the Coronation, the East Coast Roods and other abnormal events. yet it had been just as active in a less spectacular manner. We are reminded that not only is the Society concerned with these services. but it~ function is to supplement the work of the State in the prevention of disease and the promotion of the health of the community, both at home and abroad. To this end the Society is contributing its full share in co-operating with the Ministry of Health in carrying out its scheme for dealing with major accidents. Perhaps a little-known department of the Society's work is that of the trained nurses. Besides supplyin~ trained nurses to auxiliary hospitals and nursing homes at home a large number of these trained personnel are serving with the British Red Cross overseas in such places as Kenya, Korea , British North Borneo, British Honduras, Northern Nigeria, Gambia and Turkey, and many of them have received decorations for their work. The Societv takes a very active interest in the National Hospital Service Reserve, and it is interesting to note that on 31st

December. 1954. no less than 21,874 members of the Reserve, hoth men and women, had been enrolled and trained by the Society. Many of the duties connected with the National Blood Transfusion Service of the Ministrv of Health are undertaken bv members of the Society, and in some cases rhey are responsible for recruiting and maintaining panels of donors. They attend the donor sessions and often help with the clerical work as well. We learn that in Greater London 2,265 donors answered 3,368 calls from 106 hospitals during the year. Several pages of the Report are devoted to the welfare work of the Society, both in hospital and in the home, and the variety of duties undertaken by the Society'S welfare officers are certainly enlightening. It is pleasing to note that the old folk are not ovt'rlooked, and we team that 361 old folks' clubs are organized and maintained by branches of the Society, and that members assist in 295 clubs run by other organizations. 'First A id and Nllrsing' wishes the Society continued success in its grand work.

NeIl'S ""d Notes

St. George Ambulance & Nursing Corps

!\fayes' Handbook for Midwives The fifth edition has been issued by Bailli ere, Tindall & Co Ltd., 7 and 8 Henrietta Street, London, W.C.2, at a price of 20 -. It has been revised by F. D. Thomas, S.R.N., S.C.M., MTD . The basic arrangement of the work has remained the same, but the text has been brought up to date, and includes such recent advances in the practice of midwifery as intra-gastric oxygen in the treatment of asphyxia neonatorum, Lovsett's manoeuvre for the delivery of the shoulders in breech presentation, an d the use of Trilene by midwives.

Institute of Certified Ambulance Personnel The Council of the Institute of Certified Ambulance Personnel announce the election of the following Honorary Fellows : Alderman Harry Lord, M.B.E., J.P. , CA., Chairman of the Health Committee, Lancashire County Council; Will T. Paling, Member of Parliament for Dewsbury, Yorkshire; V. Whittaker, O.B .E., County Ambulance Officer, County Council of the West Riding of Yorkshire. J. D. Palmer, Senior Station Officer, Buckinghamshire County Ambulance Service. F. C Reeve, lecturer and writer on first ai~ and nursing subjects (resident in Hove, Bnghton). Dr. Winifred Shaw, Assistant Medical Officer, County Borough of Bury.

This Corps wish to extend their activities in other areas of Central and Greater London. Enquiries will be welcomed from trained first-aiders or instructors to help the formation of new detachments of the organization. Any enquirer, not living in the London Area, would be passed to the local H.Q. All communications on the above matter should be addressed to: S1. George Ambulance & Nursing Corps, 248 Finsbury Pavement House, Moorgate, London, E.C2.

More Doctors than Most With 13 doctors to every 10,000 inhabitants, Hungary now claims to be better off medlcally than most of the countries of Western Europe.

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It pays to standardise on

. LIT~ER-COTS: Wide application of aluminium litter-cots is visualized for hospital, IOdustnal and defence use, The litter-cot illustrated here was manufactured bv Simmons Machine Tool Corporation from an idea developed by the New York State Civil Defence Commissi~n. ~ingle un~ts can be used as portable stretchers or they may be stacked like bunk beds, makmg It convement to convert commercial vehicles into stand-by ambulances.

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Bedford Day in, day out Bcdfords brilliantly perform all the varied transport tasks of public authorities. No other range of vehicles has such a high reputation for reliability and economy. Modern ly designed Bedfords form the ideal 'one-make' fleet; they pay in e\'er)' H'a)! 'Onemake' transport means greatly simplified maintenance and spare part stocking. To this add the extra Bedford advantages of low first cost,

Christmas Seals make a Christmas Tree A Christmas Tree made of Christmas Seals is this year's novel idea for the hundred and ten million Christmas Seals for letters and parcels to be sold on behalf of the National Association for the Prevention of Tuberculosis. The Seals are in many different designs and combine to form a gaily decorated Christmas Tree hung with lanterns, crackers and presents. The whole sheet of 100 Seals casts 4 - and Christmas ca~ds in a similar design at 5 - per dozen (With envelopes) can be obtained from the Duchess of Portland, Chairman NAPT Tavistock House North, London, W.CI : on or after October 18th.

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fOR EYERY LOC4L GOVERNMENT NEED

Bedford Scammel Tractors from £666 plus fl19.:!.3 P.T.

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FIRST AID & NURSING, SEPTEMBE R /OCTOBER 19-55

The Repair

FIRST AID & NURSING, SEPTEMBER /OCTOBER 1955

Beaders~

queries

Squad

* First-Aider~s C,·ossword No. 19 Compiled by W. A. Potter

Answered by Dr. A. D. Belilios

When you receive a wound or a burn, your body m ob ilizes its repair squad to make good the

E. T. (London) writes :Will you please inform us the correct first aid treatment for stings from jelly-fish. This summer has seen large numbers of these fish around our shores and has rewlted in bathers queueing up at first aid posts for treatment from .stings. This matter was discussed at Charlton Works Ambulance Class and it was learned that the jelly -fish stings by contacting itself with Ivhat it believes to be an enemy and injecting poison under the skin, much like an hypodermic needle is used. What the members of the class were not clear on was the nature of the poison injected. Knowing that wasp and bee stings come under acid poison;'1g we felt that stings from jelly-fish might come under the same heading, but we were not sure. Could you clear this matter up for us, so that we can be certain of the correct treatment to be given?

damage . Infectio n by bacteria hinders th e repair squad in its "vork and may even overwhelm it, so that th e wound heals slowly or not at all.

infect ion must be prevented or sllppressed, and this some of th e older antiseptics do quite effectively. But no antiseptic, however efficient, will h eal a wound; only the rcpair squad can do that . The drawback of th e older antiseptics, sllch as acriflavine, tincture of iodine, propamidine, etc., is that they interfere with the repair squad's activities -

and thus themselves slow down the proc~ss of

healing. , Furacin " 40wever, is an entirely new type of ge~micide, which destroys bacteria and prevents

infection outstandingly well, and yet leaves the repair squad unharmed to get on with healing

Answer I do not think that the view is now held that the harmful effects of bee and wasp stings are caused by an acid. It is more likely that the reaction is caused by a foreign protein. In other words the reaction is allergic-rather like nettle rash. In any case, general principles should be followed and, if available, antis6ne cream should be applied.

the wound. For this reason, 'Furacin' is becoming more and more widely used in hospitals and hl-st-aid rooms in this country and America. Made up as an ointment, it is easy to handle, and stable, and is available in a range of pack sizes to suit all users.

FllRACIN

* SOLUBLE OINTMENT

the potent antibacterial especially designed f~r wounds and burns ,

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Available in 1-oz. tubes, 4-02. and 16-02. jars Further details on request

MENLEY & JAMES,

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D. Y. (Co. Durham) writes .--;While our competition team have adopted the Holger Nielsen method of artificial respiration we have found that the movements of the operator's arms, and the position of operator make it difficult and J would like to suggest impossible, to apply a face piece of the Novita or similar resuscitation apparatus quickly by another member of the team. We could, of course, change to the Schafer method while the face piece is applied but are afraid that judges are now looking for the Holger Nielsen method.

ACROSS 1. They can produce a wise man 7. Does it illuminate the brain? 10. Aspirate an unwelcome organism 11. Is at Italian wine town 12. So came the climax of the fever 13. Infectious for the fielder? 14. Order of duty ... 16. A girl to feed back 17. Talks from many hats ] 9. Plea to have been in another place ... 20. Shakespearian king 21. Amusing anaesthetic? 22. Injury to soft tissues at a joint 23. Pain does not distress him ... 24. Do they take 50 amps? 26. Robust .. , 28. Enough to test ability to swallow 30. Germ causing disease 31. Extremity rich in iron? ... 32. Stare, perhaps at incised wound 33. Organism could be a bare one 34. Organs in kidney essence

35. (4)

Dangerous when scattered in radio-therapy

(4)

(4) (8) (4) (4)

(8) (4) (4)

(5) (5) (6) (3) (6) (5) (5) (4)

(l,3) (8) (4) (4) (8) (4)

DOWN 2. Windy enthusiasm (5) 3. Bandage more than vitiated appetite ... ... ... (5) 4. Human transport for the injured (6) 5. 12 of pallor ... ... (2,5,2,1,5) 6. Cause of biliary or renal colic (5) 8. Mind probed by the psychoanalyst (11) 9. Receptacle much required by (8,3) physicians of old 14. To be given to all your patients (11) 15. At Balaklava and in lymphangitis ... ... (4,3,4) 17. Defence of 104 and 49 (5) 18. Reject this method of diagnosis (5) 25. Rickety chest (6) 27. A witness of the accident may (5) 28. 500 out of danger (5) 29. I'm beginning to work hard later, I suggest (5)

SOLUTION TO CROSSWORD No. 18 ACROSS · 9, Basal Metabolism; 10, tripe; 11, ash; 12, notes; 13, on the spot; 15, asses; 17, relapse; J9, reduces; 21, prate; 24, ever-ready; 28, lorry ; 29, air; 30, cruel; 31, typhoid carriers.

DOW~

], Abbattoir; 2, assist; 3, sleeve; 4, decamp; 5, catheter; 6, cornea; 7, hiatus; 8, emesis; 14, heart; 16, stupe; 18, emeralds; 20, spy glass; 21, palate; 22, abrupt; 23, etymon; 25, ear wax; 26, record; 27, amulet.

FIRST AID & NURSING, SEPTEMBER OCTOBER 1955

FIRST AID & NURSING, SEPTEMBER /OCTOBER 1955

We Jtlould greatly appreciate your vielvs on this matter and wish to thank you for the help we have had from your 'Queries' column of , First Aid and Nursing.' Answer You have, indeed, raised an important point but I do not think it is insoluble. All judges will, of course, expect continuity of the movements of artificial respiration and close co-operation is essential in applying the face-piece of an oxygen apparatus quickly by another member of the team. I asked Divisional Superintendent Howell of the Wimbledon Division to undertake experiments and he found that placing a pad about 2 in. in thickness between the patient's hands and the ground considerably facilitated the procedure. I hear rumours that new varieties of face-pieces suitable for this purpose are being devised.

L. B. J. (Bournemouth) writes In the treatment of broken ribs uncomplicated, we are told in paragraph A2 to instruct the patient to breathe out before tying the knots of

the broad bandage. What is the reason for breathing out please ? Answer The object is to immobilize the broken ribs as far as possible. If the bandages are firmly tied while the patient holds his breath af~er deflating his chest, the broken nbs will not move-at any rate to the same extent during respiration. Incidentally, pain is greatly relieved by adopting this method .

A. F. B. (Exeter) writes Coronan' thrombosis is \'ery much in the nell'~ at the moment. Iwonder if Dr. Belilios would briefly explain the condition and ;,s first aid treatment. Answer This common disease is caused by the sudden formation of a clot of blood in one of the coronary tloodvessels, i.e., those which supply the heart. Hence the circulation of blood to this organ is disorganized. Symptoms include severe pain over the heart, shooting to one of the shoulders and often down one arm, or up to the neck even into the gums. Shock is often marked and

vomiting may occur. First aid is that for shock but above all a doctor must be quickly obtained to give an injection of morphia and possibly other drugs to prevent further clotting.

Eminent Success

M. P. (Bognor) writes : I spend some of m)' evenings , sitting-in' and I,vatching an elderly lady who has a lVeak heart in order to alloll' the relatives to go out occasional1J' to the cinema, etc. The. patient is 'often very confused mental1y-does not recogni::e me although J am an old friend and often makes stupid remarks and undertakes peculiar actions. It seems as ~f her brain is affected. Can you give me al1)' explanation for her conduct ?

ALUDROX Amphoteric Gel occupies a pre-eminent

position in the successful medical treatment of the peptic diathesis. In neutralising acid, partially inactivating pepsin, and encouraging mucosaL resis-

tance, it deals rapidly and effectively with three of the main factors incriminated in the genesis of gastro-duodenal ulceration.

Aludrox Gel is presented in 6-oz. and 12-0Z. bottles. Aludrox Tablets are presented in boxes of 60 13-grain tablets.

Answer Th is symptom is generally due to an insufficient blood supply to the brain caused by the weakened action of the heart. There are, of course, other causes, e.g., changes in the brain due to old age.

Aludrox 'AludTOx' is the registered trade mark of

JOHN

Owing to iack of space certain reports on competitions have had to be held over until the next issue.

CLIFTON

WY E T H HOUSE,

BROTHER

EUSTON

ROAD,

Aid for the Brit,ade

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FIRST AID & NURSING , SEPTEMBER/OCTOBER 1955

UNIFORMS and LADIES~ GREAT COATS & COSTUMES MEN~S

FlRST AID & NURSING , SEPTEMBER /OCTOB ER 1955

r B

PATENT

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for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

AMBULANCE GEAR

Th e Gea r illustrated(A.B. C.D .) carries tw o stretchers o n on e si de of A mbulance, leaving other si de clear for sitti ng patients. Th e UP AND DOWN acti o n is qUIck an d easy for loading o r unl oading. A . Shows the two stretchers in position. B. Sbows the top stretcher lowered ready

for loading.

HOBSON & SONS (London)

C . Illustrates the saUle Gear With the top stretcher frame hinged doW1~ for u!oe when onlv one stretcher case is carried. .

D. Shows tbe same po,ltion as in "C' only with cushions and back rest fitted fOT convalescent cases.

UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS 154 -164 TOOLEY STREET LONDON BRIDGE S.E.1 'Phone:

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'Grams:

W here Ambulances are required t o carry four beds two Gears are fitted, one on EITHER SIDE. and the same advantages apply as d esc ri bed above.

"Hobson, ' Sedist, London"

Full ca talogue of Ambulance Equipment N~. 7A will be sent on request.

~,----------------

65, WIGMO RE STREET, LONDON, W.I 'Phone: WELbeck 0071 (Late GREAT PORTLAND STREET)

BAILLIERE'S HANDBOOK OF

Nineteenth Edition. Completely revised. 261st thousand 286 pp., 286 illustrations, some coloured , 65. 6d., post 4d.

ELEMENTARY NURSING

WARWICK AND TUNSTALL' S

FIRST

AID

TO THE INJURED AND SICK Edited by A. P. GORHAM, M. B., Ch . B., M.R .C.S.

Police Surgeon, City and County of Bristol

'FIRST AID' WALL DIAGRAMS 26 X 40 in.

THE HOUSE

FOR

HUMAN SKELETONS Articulated and Disarticulated HALF SKELETONS, Etc., Etc.

METHODS OF ARTlFlCIAL RESPIRATION

A- G Anatomy and physiology . H- J The triangu lar band . ge . K, L The roller bandage. M, N Haemorrhage a nd woun ds. 0 , P Dislocat ions and fractures . Q . R Transport. S, T Art ifici a l resp ira ti on . Single Sheets :

Human Osteology, Anatomy, Etc. 18 FITZROY STREET, FITZROY SQUARE, LONDON, W .1

by Arthur D.

Johnstone , S.R.N.

This is in many ways a unique book. First aid books as a rule confine themselves to injuries, e.g. fractures, wounds, burns, scalds etc. This book does not. It covers medical conditions of all kinds and much of the information is not to be found easily elsewhere. There are chapters on : Case-taking, medical causes of unconsciousness, internal haemorrhage, first aid in maternity cases, first aid in spinal injuries, asphyxia, industrial poisoning, use of morphia. 'Undoubtedly the best of its kind' Nursing Mirror. Fourth Edition. xii + 476 pages, 200 drawings. Price 8s. 6d.

This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. It describes in simple language the hasic principles and procedures that underlie the science of nursing, and contains brief descriptions of the more common diseases with general notes on the nursing required in each case. A complete chapter is devoted to the subject of home nursing, and the whole b:)Ok provides for e\ ery first aider the essentials of nursing in a ha ndy yet comprehensive form. '( + 314 pages, 57 drawings. Price 75. 6d.

Belilio~, M.B., B.S., D.P.H.

and Dorothea DIIIICOIl-

Linen - 65. 6d., post 4d . Paper - ls. 6d., post 4d. Set of 20 , on Roller ; Linen - 1315. 6d., post free .

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by ArtiIur D. Belilios, M.B., D .P .H., D. K. MlIlvany, M.S., lvf.B., F.R.C.S., F.R.C.P., and Katharine F. Armstrong, S.R.N•• S.C.M.

The Briti sh Red C r oss Soci ety have speciall y adopted a se t of 6 sheets, A. D. M. N , O. p. whi ch ca n be supplied on linen w ith fitti ngs for t he special price of 405. post Is. 3d.

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or BAILLIERE, TINDALL A D COX, 7-8 Henrietta Street,

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AND

London, W.C.2.

Name ........... Address ............. ..

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

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ALL-METAL A NE 2-STRETCHER AM ULANCE ON THE LAND ROVE 107 in. WIB CHASS S

FIRST AID &: NURSING

No. 709, Vol LX

are primarily caused by Staphylococci, Streptococci and B . Pyocyaneus . A really effective ointment must therefore strike at these micro-organisms. SKIN

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Printed by How AIm , JONES, ROBERTS & LEETE, Ltd .• 26-28 Bury Street, St. Mary Axe, London, E.C.3, and published by the Proprietors, DALE, REYNOLDS & CO ., Ltd., at 32 Finsbury Square, London, E.C.2. to whom all communications should be addressed.

NOVEMBER/DECEMBER 1955

INFECTIONS

ANTIPEOL CUTANEOUS OINTME T is a preparation which incorporates the sterile broth filtrates of the three infective microbes in an ointment base of proved efficiency further to accelerate the process of rapid healing.

TREATMENT

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ANTIPEOL is therefore an essential component of every First Aid and l\nrsing Kit.

antipeol cutaneous ointment Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTIPE.OL for .ocular infections; DETENSYL for reducing arterIal tensIOn. MEDICO-BIOLOGICAL LABORATORIES LTD .• CARGREEN RD .. SOUTH NORWOOD.S.E.2S

FIRST AID & NURSING, NOVEMBERIDECEMBER 1955

Bedford The' one-make fleet

First Aid &

Lomas "B type" ambulance on Bedford A2 ambulance chassis. Prices from. . . £1,323 .

°.°

~~~~~!

Nursing

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D;C;S;,J"

B.,;I,1 TI.e;r fl."" HeadquIlrters The Somerset County Commissioner. Col. C. T. Mitford-Slade, D.L., J.P. , recently performed the opening ceremony for the new. ~e~d quarters of the Wed more Dlvlslon

of the St. John Ambulance Brigade. These quarters were constructed by the members of the Brigade themselves, carrying out the work in their spare time.

Editor: Peter 1. Craddock This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.C.2, for the purpose of provi~g an inf?rmative technical service on first rud and nursrng. We welcome contributions.

November/December 1955

In this Issue

Tippers from £818 plus £141.5.4 P.T.

It pays to standardise on

Bedford Day in, day out Bedfords brilliantly perform all the varied transport tasks of public authorities. No other range of vehicles has such a high reputation for reliability and economy. Modernly designed Bedfords form the ideal 'one-make' fleet; they pay in el'ery 11.'ay! 'Onemake' transport means greatly simplified maintenance and spare part stocking. To this add the extra Bedford advantages oflow first cost,

low upkeep cost, low-priced readily available replacements, and Square Deal Service from 520 authorised Bedford dealers. With a range of chassis covering all loads from 10 cwt. to 10 tons, there is a Bedford for every local government needyou see them everywhere. Full particulars from your local Bedford dealer, orwritedirectto the Municipal Vehicle Department, Vauxhall Motors Limited, Luton, Beds.

FOR EVERY LOCAL GOVERNMENT NEED

Road Sweepers from £1,982

Lorries from £679 plus £126.17.2 P.T.

Cesspit Emptiers from £1,::!84

'1.1 Iiii

Division Build own Headquarters First Aid at Festive Seasons... 2 Mental Health Exhibition 3 4 Grand Prior' Trophies New Method of Staging Com6 petition Tests Additional Removal Test in 7 Competition Local Authority Fire Brigades 8 Finals 9 Annual Report From a Seat in the Audience [0 10 First-aider's Crossword 12 Readers' Queries 14 Obituary

40-Seater Buses from £2,575

Bedford Scammel Tractors from £666 plus £142.18.8 P.T.

no you k,.ow that . .. 1.

Vans from £4{)0 plus £72.19.2 P.T.

Crew Buses from £513

3. 4.

Tower Wagons from £1,087.10.0

5. 6.

The Schick test was introduced by Prof. Schick, of Vienna, in. ~9J3, for the purpose of deternlll1lng . the susceptibility of individuals to dIphtheria .) If no thermometer is available,. the dorsal (back) surface of the. middle phalanx of the flexed finger IS most sensitive to changes of temperature, and is a good substitute? . Prescriptions for enemata have ~I equentlv been found on Babyloman . and Assyrian tablets ? It is now known that the III-health suffered by De Quincy, .Carlyle, Darwin, Huxley and Browmng ,~as attributable to ocular defect leadlllg to eve-strain ? The iife of an erythrocyte (red bloodcorpuscle) is about three "ee~ ? Marking ink on babies ' n~pples can be absorbed thro~gh ~he ~kll1 and can thereby cause pOlsomng .

(Top)

The County Commissioner congratulating the members.

Division Superintendent L. Puddy (seated centre) with members of the Wedmore Division (Somerset) following the opening ceremony.

(Bottom)

CHRISTMAS and the New Year are upon us and some firstaiders have asked whether there are any special emergencies liable. to occur at these festive seasons whIch may require their services. Naturally, any form of accident or illness may occur at this time of the year and the first-aider must, as usual, be prepared for anything, ranging from a dislocated jaw through over-yawning during the sermon on Christmas morning to a fractured spine caused by falling off the steps while arranging Christmas decorations! Nevertheless there are a few special hazards that may be described in this article. Overeating.- This may result in acute gastritis. In the average case, there is discomfort in the abdomen, loss of appetite, nausea and vomiting which gives relief. A headache is not uncommon but the temperature is usually normal although sometimes it may be slightly raised. These symptoms may last for one to two days. Considerable caution must be exercised in making a diagnosis of overeating since the symptoms may be due to a more serious cause such as one of the abdominal emergencies described in the last article. The case must be treated on general principles. Bed and starvation are desirable. When vomiting is present, no harm will result from giving a tumblerful of warm water to which a little bicarbonate of soda has been added. Aperients such as castor oil should only be given if ordered by a doctor whose advice should be obtained if the patient does not rapidly improve. Food poisoning.- lt would easily be possible to write a long article on this subject which can be defined as any illness due to the ingestion of unwholesome food or drink. This definition includes, therefore, foods and drink contaminated by chemicals, eating poisonous plants such as

FIRST AID & NURSING, NOVEMBER/ DECEMBER ]955

deadly nightshade and many others. The most common variety of food poisoning, however, is due to the presence of germs or bacteria in food or drink and this causes acute gastro-ententls. The germs in question are generally members of what is known as the Salmonella fan-uly and they may gain access to foods and drinks in various ways. Animals, for example, ducks, pigs, cows and many others may themselves be suffering from infection with Salmonella germs which may escape destruc60n if the food is insufficiently cooked; other al-umals such as rats and D-uce suffering from the disease may contaminate foodstuffs by their excreta. Human beings may themselves be carriers and unless they are most hygienic in their habits may contaminate food by handling. Symptoms vary considerably in their severity but usually consist of abdominal pain, nausea, vomi ting and diarrhrea together with shivering, sweating, giddiness and headache; collapse may occur. The onset of the illness is sudden and may begin within an hour of partaking of the poisoned food; on the other hand, it may be delayed for as much as two days. Similarly the duration of the attack is variable. First aid is similar to that advised for overeating with special emphasis on obtaining a medical opinion not only to confirm the diagnosis but also to order suitable medicines and to give advice to prevent spread of the disease to others. Overdrinking.-This, of course, refers to alcohol which is in fact a narcotic poison although when taken in small doses appears to have a stimulating effect, shown by the patient becoming excitable, loquacious, witty and less reserved in his manner. These characteristics, however, are caused by the drink abolishing the normal critical powers of the brain. There is no objection of

course to the sense of well being produced by reasonable ind ulgence in cocktails etc. at festive seasons and on other occasions provided that they are not taken to excess or allowed to interfere with responsible duties e.g. performing first aid, car driving etc. The symptoms and signs of alcoholism are well known to the average reader. They include slurred speech, a quickened pulse, a flushed face and dilated pupils. Giddiness and vomiting are commonly present. Disturbances of the muscular system are common; these comprise inability to walk straight and maintain balance and also to perform fine actions with steadiness and harmonious action of muscles e.g. placing a key in a door latch, writing etc. There is a smell of alcohol in the breath, but this in itself does not justify a diagnosis of drunkenness ; anyone who is feeling ill, such as a patient suffering from an illness e.g. the early stages of apoplexy, may take or be given alcohol as a supposed stimulant; the disease itself may develop producing its own characteristic signs, which, to the first-aider, may be sin-ular to those caused by alcohol. If the odour of the breath alone is allowed to influence the diagnosis a serious error may be made with even fatal results to the patient. In severe cases of alcoholism the patient becomes comatose witll a pale face and often blueness of the lips. The temperature of the body is below normal and the pulse quick and weak; the breathing is deep and regular and often accompanied by stertor. Fhst aid depends Oll the severity of the case. If it is mild, very little treatment is needed except for careful observation and general assistance e.g. while the patient is vomiting, going to bed ctc. Coffee may be given as an antidote. The more severe cases such as those in which the patient becomes stuporous or comatose call for medical assistance and possibly removal to hospital since a severe degree of drunkenness must be considered as bad as narcotic poisoni ng. The general principles for the treatment of unconsciousness must be put into operation with particular emphasis on observation since there are several important risks to be avoided. A patient, for example, may vomit and then inhale drawing the contents of

•

FIRST AID & NURSING, NOVEMBER/DECEMBER 1955

his stomach into his air passagescausing asphyxia. This can be avoided by the first-aider who supports the head of his subject while vomiting is taking place. Another patient may injure himself through a fall while attempting to walk in a semi-conscious condition. Swallowed foreign bodies. Charms such as small rings, threepenny bits etc. put in the Christmas pudding may be accidentally swallowed. This, of course, should not occur if proper precautions are taken. A wise cook wraps such charms in a square piece of doubled grease-proof paper considerably larger than the foreign body, twisting up the ends so that the object is conspicuous; moreover by this method contamination of the pudding with a base metal is prevented. Nevertheless such accidents do occur while children may also swallow parts of toys given as Christmas gifts e.g. eyes from dolls, or nuts and bolts from big brother's meccano set. A swallowed foreign body always causes alarm both to the anxious parents and to the patient alike but it is not usually a serious condition if the objects are reasonably small in size. The smaller coins, rings and similar articles will generally pass naturally through the stomach and intestines and leave the body in the stools without causing trouble. There is not much for the firstaider to do. Under no circumstan-

ces should he give an emetic or an aperient such as castor oil which might have the effect of so stimulating the movements of the intestines that the foreign body is forced against their delicate walls and damage or even perforation-if the object is a sharp one- caused. Drinks also should be avoided but stodgy food, for example, some more Christmas pudding may be given with the object of wrapping round the foreign body and making it less liable to cause damage. Medical advice should be obtained since, if there is any doubt a series of X-Rays may have to 'be carried out to watch the passage of the foreign body during its course through the intestinal tract. The motions themselves must also be carefully examined and searched for the object. . Sometimes an operation has to be performed if the foreign body remains stationary or shows signs of causing obstruction. Burns and Scalds.- These, of course, are common at any time and form a big subject in first aid; they will be more fully discussed in a subsequent article. At festive seasons, however, they are particularly liable to occur both in minor and severe degrees. A most unpleasant accident results when a patJent's clothing, perhaps a flimsy party frock, catches fire since extensive burns may then

be caused producing severe shock and often threatening life. The first-aider must endeavour to smother the flames. He must quickly approach the patient holding a rug or other relatively uninflammable article e.g. a mat, in front of himself for personal protection. Th~ patient must be forcibly made to lie down so that the flames are upperm.ost and hence burning of his body Will be restricted in their extent. The rugs are then used to smother the flames since burning of the clothing cannot continue in the absence of oxygen. Subsequent first aid is that for shock undertaken to its fullest extent while a waiting the arrival of a doctor who will probably order the patient's removal to hospital where fuller treatment for this dangerous accident can be performed. If a patient's own clothing catches fire, he should lie down immediately and call for help. Under no circumstances should he attempt to run for assistance since this action would tend to increase the flames. He should endeavour to put out the fire by rolling on the floor and smothering the flames with the nearest wrap that is available. A happy Christmas and a bright and prosperous New Year to all those readers who foHow these articles; I hope I have not depressed anyone by this article on First Aid at Festive Seasons! !

THOSE of our readers who follow the fortunes and misfortunes of . The Archers' in the Ught programme will recall that some months ago Jack Archer, who was rapidly approaching a mental breakdown, was induced to enter, voluntarily, a modern mental hospital, and after a few short week of treatment by modern scientiAc methods, returned home completely cured. Many listeners regarded the story as pure propaganda and very much exaggerated, but visitors to the Mental Health Exhibition at the Central Hall, Westminster, recently organized jointly by the Ministries of Health and Labour and National Service, and opened by the respective Ministers, under the chairmanship of Councillor Patrick Stirling, J.P., Mayor of Westminster, soon realized the advances which had been made in this department of medicine since the old' lunatic asylums.' No longer are the inmates looked upon as dangerous prisoner, unAt to take their place in society, or the attendants as mere warders. It is now realized that these patients are sufIcring from illness of the mind just as the patients in a general hospital are

suffering [rom disease of the body. Moreover, it is being shown daily that in a very large percentage of the cases complete cures can be effected, and that the stigma which once attached to confinement in the old institution no longer exists. Perhaps the most important fact learned from the exhibition was the difference between mental illness and mental deficiency, and the treatment and nursing of each in the light of modern knowledge. The exhibition fell naturally into two parts, one pictorial and the other practical. In the first part photographs and captions explained these differences by describing three typical cases. On the practical side electrical and otber apparatus was exhibited and explained, and sister tutors gave practical demonstrations of nursing techniques and equipment. A representative display of occupational tht"rapy was most enlightening, and there were models of new mental hospitals and units planned or under construction. Through the courtesy of the organizers of the exhibition we are reproducing here two photographs, one showing patients engaged in productive work

(occupational therapy) and the other a psychological test being conducted by a psychiatrist, which reveals the patient's troubles and enables a diagnosis to be made. We had a long chat with Mr. Bartiett, principal tutor at the Claybury Hospital for ervous and Mental Disorders, Woodford Green, Essex, who described the interesting training course given to students taking up this fascinating work. We have no hesitation in advising those who intend making nursing their career to select this interesting department of the profession. Ln the new year it is proposed to take the exhibition on a tour of the provinces, and in order to enable those of our readers living in or near the districts it is intended to visit to mark their calendars in advance, Mrs. Samson, the Public Relations Officer, kindly ga\e us the following list of places and dates which had alreadv been Axed: 2nd January-Manchesfer. 23rd January- Durham, 6lh February-Preston. 5th March-Beverley, 17th Ma~ch-York, 19th March-Carlisle, 5th May- Lancaster, 12th May-Rhyl and District.

FIRST AID & NURSING, NOVEMBER/ DECEMBER 1955

PriorfJ s Trophies 'A LL roads lead to Rome' and all S.l.A.A.

competitions lead to the Grand Prior, for this is the Mecca towards which all competition teams strive, and which all hope to reach. This grande finale was held again this year al the Porchester Halls, Bayswater, when no Jess than 13 men 's teams and 7 women's teams, competed, each having won the Final of their own respective organization. The tests were stiff, and the competitions keenly contested, but every single team acquitted itself well. The men's team test, which was set and judged by Major A. e. White Knox, O.B.E., M.C., M.B., Ch.R, Principal Medical Officer for the Association, was set on a lake in a park. A young man is seen rowing his fiancE.e when his boat hits the landing stage, upon which he falls heavj]y, sustaining a wound on the upper forehead, with a depressed fracture of the skull, slight haemorrhage, concussion which develops into compression 10 minutes after the commencement of the test, a Potts' fracture of left leg and a compound fracture of right radius with severe haemorrhage, bone protruding two inches above the wrist.

Emphasis on observation . D. J. Johnson Esq., M.B.E., T.D., M.R.e.S., L.R.e.P., of Oswestry, was responsible for the women's team test, with the emphasis on observation. A woman calls the team to treat her son whom she has found in a smoke-filled room. Besides being partially asphyxiated, he has a simple fracture of the right tibia with a lacerated wound of the thigh. The baby, lying in a cot in the corner of the room (if found) appears to be dead. . The .dual practical tests were equally mterestmg ; Nos. 1 and 4 men are on duty at a sports meeting, and are called upon to treat a sportsman suffering from a Colles' fracture of right wrist, sprained right ankle and shock. Nos. 2 and 3 men, on duty at the same sports meeting, are asked to treat one of the canteen assistants suffering from scalds on hands and face and simple fracture of 8th and 9th ribs. These tests were set and judged by E. J. Gordon Wallace Esq., M.B., Ch.B., of Weymouth. Nos. 1 and 4 women find a man, who has been bottling fruit, with a burst bottle. A fragment of glass has penetrated the upper arm, causing severe haemorrhage. Both hands are also badly scalded and he is suffering from shock. Nos. 2 and 3 women have to treat a ~oman who h~s been electrocuted by puttlOg her hands mto a pail of water which is in contact ~ith a bare wire. Her injuries are asphYXla and burns of right four fingers and right knee. These tests were set and judged by Ian Mackenzie Esq., M.B., B.S., M.R.e.S., L.R.e.P., of Derby. Presentation Ceremony At 2.45 p.m. Her Worship, the Mayor of Paddmgton (Miss Catherine P. Rabagliati, M.B.E., J.P.) arrived at Porchester Hall and was received by the Chancellor of tl?-e Order of St. John, (Lieut.-General Sir Henry Pownall, K.C.B., K.B.E.,

D .S.O., M .e.) and the Director-General of the St. John Ambulance Association (HoraceF. Parshall Esq., T.D., M.A.Oxon.). A quarter of an hour after H.R.H. The Duke of Gloucester, K.G., K.T. , K.P., P.C., G.e.B., G .e. M .G., G.e.V.O., Grand Prior of the Order of St. John, arrived and was received by the Mayor of Paddington and the Chancellor of the Order of St. John, after which the Mayoress of Paddington (Mrs. Reginald Davy) , the DirectorGeneral of the Association, together with his executive members, representatives of the organizations who were taking part, the representative of the Associated British Picture Corporation Ltd. and representatives of the St. John Ambulance Association were presented to His Royal Highness. Before retiring for tea His Royal Highness witnessed the last team competing in the test. At the presentation ceremony the chair was occupied by M r. Parshall, DirectorGeneral of the Association, who was supported by the Grand Prior, the Superintendant-in-Chief of the Brigade (The Countess Mountbatten of Burma, e.T., G.B.E., D.C.V.O ., Dame Grand Cross), the MayC?r and Mayoress of Paddington, the ReceJVer of the Order of St. John

H.R.H. The Duke of Gloucester presents the trophy to the winning Ladies team, Eastleigh accounts, representing the British Transport Commission (Railways and Docks). Miss E. M. Barden is the Captain.

The Exmouth Junction team, representing the British Transport Commission (Railways and Docks), winners of the men's trophy.

(Lewis G. Whyte Esq.), Deputy-DirectorGeneral (Lieut.-Colonel E. e. Croft), the Commissioner-in -Chief, SJ .A.B. (Lieut.General Sir Otto Lund, K.e.B., D.S.O .), the Secretary-General to the Order of St. John (C. T. Evans Esq., e.M.G.) and the judges. Opening the proceedings, the Chairman Mr. Parshall, said' On behalf of the St. John Ambulance Association, and of all those here today, 1 wish to express to you, Your Royal Highness, the extreme gratitude and pleasure we feel at your presence at this gathering. Your continued practical interest in this great work is an immense encouragement to all of those engaged in it.' He went on to welcome the representatives elf the greal industries which had sent teams to the Competition, for it was an indication of the interest taken in the movement by tbose industries. There were many to whom he would like to express the thanks of the Association, and it was difficult to single oul individual names. He would, however, like to thank particularly the Associated British Picture Corporation Ltd. for their continued generosity in supplying and erecting the scenery which contributed so much to the realism of the tests. The stewards and

FIRST AID & NURS[NG, NOVE MBER/ DECEMBER 1955 , palien.ls,' and especially lhe judges, those profeSSIOnal gentlemen who so readily gave of tbeir time and skill to further the work and withoul whom these competition~ would not be possible. Their comments were always regarded as most valuable and they (the listeners) were always abl~ to learn something from them. He asked Major White Knox to comment upon the men's team test.

12. Grimsby and fmmingham (NatIonal Dock Labour Board AmbulanccCentre) ... . .. \91 13. Harwell (U.K. Atomic Energy ~uthority) ... ... ... 173 I t w~1l be noted that Exmouth Junction and Bnghton Police tied for first place, but the Trophy was awarded to the former as they obtained the highest marks in the Team Test.

More Care with Haemorrhage Major White Knox said that, although he may be Principal Medical Officer for the Association, he occasionally made it his business to judge a competition in order that the practical experience will enable him to keep in touch with the advances which are made from time to time, as well as to watch the progress of competition work generally. He was pleased to say that the teams he had judged lhat day had been magnificent, and it had been very difficult to separate the first six teams . With regard to diagnosis, some of the teams had commenced their detaIled examination well but there had been a tendency to tail off: He would like to have seen more care taken in dealing with haemorrhage. He wanted them to apply direct pressure on the bleeding poinl. 1n avoiding a foreign body the diagonal bandage had, in most cases, been applied weU-and then the whole thing had been spoiled by tying the knot over the wound! Some of the teams had used a collar-and-cuff sling to immobilize a Colles' fracture. However, to sum up, he had to admit that they had come extremely near perfect.

Women 1. Eastleigh Accounts; British Transport Commission (Railways and Docks) ... . . 303 ~ (winning the S.l.A.A. Championship Trophy) ... . .. 2. S. D. Elstow (Ministry of Supply Ambulance Centre) ... ... 300 3. North Area T.M.O. (G.P.O. Ambulance Centre) ... .. 2?7 4. Chelmsford (The St. John Ambulance Brigade) ... ... 286} 5. Chiswick (National Road Passenger 'Transport Ambulance Association) ... 280 6. Swindon (British Electricity Ambulance Centre) ... 264 7. Aldermaston (U.K. Atomic Energy Authority) 235~ Amid tremendous applause the Grand Prior rose to present the Trophies. He said ' It is always a pleasure to me to be able to present the Trophies which are named after the Office I hold in the Order of St. John, and I am very glad to be here again this afternoon.

Artificial Respiration- much to be desired Dr. Johnson commented upon the extreme keenness of the co.mpeting teams, but he and Dr. MackenZie were agreed that Artificial Respiration had left much to be desired. In some cases he had seen padding pushed in after the splinting had been completed, but, on the whole, the first aid had been good. The Chairman then called for the results, and these were announced by Lieut.Colonel Croft, the Deputy-Director-General : RESULTS Men: I. Exmouth Junction M.P. No. 1 British Transport Commission (Railways and Docks) (winning the S .l.A.A. Championship Trophy) ... ... 303 2. Brighton Police(The St. John Ambulance Brigade) ... 303 3. Birmingham City Police (National Police) ... ... ... 298 4. Liverpool Street 'A' (RT.C. Police) ... ... . .. .. 292 5. Chiswick (National Road Passenger Transport Ambulance Association) ... ... .. 253 6. Great Yarmouth (National Fire Brigade) 244 7. Weymouth H.P .O . (General Post Office Ambulance Centre) 237 8. North Western Gas Board (Gas Tndust ry) . .. . . . 236 9. Lewis Merthy Colliery (Miners' National F.A. Competition)... 215 10. Great Yarmoulh (British Electricity Ambulance Centre) ... 213 11. Fort Halstead A.R .D.E. (Ministry of Supply Ambulance Centre) 193

Instituted in 1950 'These competitions were instituted in 1950, and when I presented the Trophies in that year there were 7 teams taking part, whereas to-day not only has the number of men's teams increased to 13 , but there are also 7 women's teams competing. This is a great achievement and indicates the importance which is attached to these events by everyone connected with First Aid. Competitions help to arouse interest in the work of the Association and of maintaining the efficiency of men and women already trained, and therefore fully deserve the high place they take in our activities. , When I congratulate all the teams who have competed here to-day on the high standard reached, 1 do not forget all those who have taken part in earlier competitions and eliminating rounds. These a mount in all to over 2,200 teams, both of men and women, so that you can see that to-day represents the results of many hardfought contests. 'Our thanks are due not only to the doctors, patients and stewards who have all given their time so generously, but also to the great organintions who are represented here today. As President of the St. John Ambulance Association I wish to express our appreciation of the co-operation which they have given us and of the keenness which they show towards First Aid. Our competitions to-day represent the best in this way the country can show, and we may be proud that the example set in Britain has been followed by thousands in so many different parts of the world. The great Dominions all have their St. John Ambulance Associations and the progress made each year shows how high a value is placed upon the work they do. In the Colonies not only are the numbers of

classes increasing, but more and more men and wom~n are coming forward lo give their serVices through the St. John Ambulance Associalion and Brigade. 93,000 gain certificates 'During 1954 over 93,000 candidates were successful in gaining certificates in England, Wales a~d orthern Ireland, and over 182,000 certIficates were issued overseas. This is a fine achievement and an encouragement lo conti nued effort to expand our activities even further. , In conclusion, I once again congratulate all wh~ have taken part as organizers or competltors and offer my special congratulations to the two teams who have ~on the men's and the women's competitions. , I shall now have pleasure in presenting to them the Grand Pnor'~ Trophies which are before me, and in distributing medallions to the first three teams in each competition.' To conclude this pleasant ceremony a Plaque was presented to the team leader of last year's winning nursing team Cadet Superintendent Miss Irene Blackma~, of the Brighton Nursing Division, S.J.A.B. Lieut.-General Sir Henry Pownall, Chancellor ot:-the Order, said that this was the peak of the Association's competition year and referred in glowing terms to the work which has been put into it by all concerned. He felt, however, that there was one whose name had not yet been mentioned but whose influence was felt by alL He referred to their keen and enthusiastic Director-General, Mr. Parshall, who, with a. small but efficient staff, had been responSIble for the smooth-running of this gigantic organintion for so many yeaTS. He welcomed, also, the Mayor and Mayoress of Paddington who had shown their keen interest in the work of the Association. Finally, it was his pleasure and privilege to express, on behalf of the Association, the competitors and that vast audience, the pleasure which the presence of His Royal Highness had given. The practical interest which he had always shown in the movement was an inspiration and encouragement to them in their work for humanity.

Royal Society of Health Congress In connection with its annual Health Congress-the largest in the world-to be held at Blackpool from April 24th-27th, 1956, the Royal Society of Health is also to tage a Health Exhibition. The Exhibition will include products and equipment designed to maintain and improve standards of public and industrial health, hygiene and sanitation.

Bath Lift A leaflet has been issued dealing with the , Levit' bath lift for the elderly, infirm and the disabled patient. The sole suppliers for the equipment are John Bell & Croydon, Wigmore Street, London, W.I.

Read from Cover to Cover Chatting recently with Dr. Norman, the Principal Medical Officer to London Transport, he informed us that 30 copies of each issue of First Aid and NlIrsing are ordered for distribution to the members of the London Transport Ambulance Centre. ' I myself' be added ' read it from cover to cover.'

FIRST AID & NURSING, NOVEMBER/DECEMBER 1955

FIRST AID & NURSiNG, NOVEMBER fDECEMBER 1955

National Road Passenger Transport Finals

Ne,v Method of Staging CODlltetitioll Tests THE

Finals of the National Road Passenger Transport Ambulance Association for the 'Stirk' Trophy and the' Lewis' Cup were held at the London Transport Aldenham Works, Elstree, Herts, and despite the fact that the Aldenham Works are situated a dozen miles outside London, the tests were watched by a large crowd of enthusiastic spectators. The , Stirk' Trophy was presented by the late John H. Stirk, Esq., East Midlands Traffic Commissioner, and the 'Lewis' Cup by H. D. Lewis, Esq., Secretary of the National Road Passenger Transport Ambulance Association, for competition by women. The new method of staging had been adopted for the tests. By this means the team tests, the individual tests and the oral tests are all arranged on a central stage, each being separated by a partition, thus enabling the spectators to pass round and watcn whichever test they wish instead of passing from room to room. Each team had to submit to a team test, dual practical and oral tests.

Men's Team Test: The team is called by a woman to a warehouse where her husband, who is the night watchman, has been attacked. Examination reveals that he is bound and unconscious, and is suffering from a depressed fracture of the skull, concussion developing into compression, a dislocated right shoulder, an incised wound of the left hand and a simple fracture of the right tibia. The test was set and judged by Dr. C. M. H. Rotman.

'Nomen's Team Test: At a 'bus stop in the country the team finds a man lying on the ground with a note pinned to his clothing stating that a cyclist has gone for help. A bloodstained handkerchief is tied round the left forearm under which glass (removable) is found in the wound. There is bruising and swelling over the right temporal region causing concussion, and there is, also a simple fracture of the right patella. The test was set and judged by Dr. G. M. Shaw Smith. Nos. 1 and 2 : These members are called to render assistance to a man who has fallen and pulled a filled teapot over his left leg. fniuries: Scalds with blisters and a sprained right ankle.

Nos. 3 and 4 : A night watchman is found lying unconscious on the floor of his hut in front of a coke brazier. Injuries: Asphyxia and Potts' fracture of left leg. The dual tests were set and judged by Drs. J. C. Graham and L. Wills.

Oral Questions: 1.

State (n) General treatment of spinal injury; (b) How to prepare a patient for transport who is sufferi ng from a fractured spine. What would you do jf called to a man who is unconscious from a blow on the head ?

How are fractured ribs sustained.? Give special signs, symptoms and treatment. 4. What uses of cold are mentioned in the First Aid text-books? These were set and judged by Drs. E. W. Tapley and R. Renwick. The presentation ceremony was presided over by Mr. J. R Burnell, Operating Manager (Central Road Services), London Transport and President of the National Road Passenger Transport Ambulance Association, and amongst those supporting him were Mr. Alex. J. Webb, General Superintendent (Staff and Training), Railways and Chairman of the London Transport Ambulance Centre, Mr. John Cliff, Deputy Chairman, London Transport, Mr. L. e. Hawkins, Dr. L. G. Norman, Chief Medical Officer, London Transport, Mr. H. D . Lewis, Secreta ry of the National Road Passenger Transport Ambulance Centre and donor of the 'Lewis' Cup, Mr. Horace F. Parshall , T.D., M.A.(Oxon), Director-General of the St. John Ambulance Association , Major A. e. White Knox, O.RE., M.e., M.B., Ch.B., Principal Medical Officer of the St. John Ambulance Association and others. The Chaimlan, in extending a welcome to all those present. commented upon the large number who had attended. He was esp-ecially pleased to have with them that day Mr. Parshall and Major White Knox. From the latter he had learned much. He also extended a special welcome to Mr. and Mrs. John Cliff and Mr. and Mrs. L. e. Hawkins. 'We would also like to thank Mr. F. C. Reeve' he said, ' and that very fine journal First Aid and Nursing which he represents, for the excellent reports they continue to publish of these competitions.' Mr. G. Craft, competition secretary, read the results of the competition : MEN (Possible marks-600) Marks 1. London Transport 422} (winning the 'Stirk' Trophy). 2. Birmingham Ci ty Transport 408} 3. Liverpool City Transport 393~ 4. Nottingham City Transport 342 ~ 5. Preston Corporation Transport 321 305 6. Coventry City Transport WOMEN

London Transport 340 (winning the' Lewis' Cup) . 2. Liverpool Transport 324~ 3. Cardiff City Transport 282 4. Midland Red Motor Services 278 246 5. Birmingham City Transport The comments by the judges are always regarded as most valuable, and Dr. Rotman opened the ball. He stated that some of the competitors did not appear to appreciate the severity of the situation, one competitor remarking 'I think he fell off the roof' despite the fact that the patient was bound with ropes. They must practice observalion/ One team argued with the policeman over some trivial legal point. They must ignore all minor considerations in favour of attending to the patient. He congratulated those teams which cleared

up after them and 'left the place tidy. The pulse must be taken for at least half-aminute. In this they must not be impatient, and he emphasized the importance of a rapid grasp of the whole situation. Replying to queries he had heard raised concerning the time allowed for the test he assured. the competitors that a pilot test had proved that it could be done in the time. Transport, he said, was poor, and needed more practice. In conclusion he thanked the St. John Ambulance Association and the National Road Passenger Transport Ambulance Association. for having invited him to judge that day. He was followed by Dr. Shaw Smith, who had judged the women's team test. Dr. Smith commenced by commending the team who, unable to obtain water for a compress, used that from a puddle-it had been raining. Whenever a patient is found unconscious it is necessary, first of all, to discover why, and this could not be done if the patient were lying on his face, but care must be taken in turning. The wound on the arm demanded immediate attention, and he criticised the time lag by some teams in applying digital compression, after removing the foreign body. Insufficient use was made of bystanders who, he said, would have been willing to help if told what to do. Dr. Wills criticised some teams for their delay in getting the watchman out of the hut into the fresh air. In applying H.N. the arm was often not lifted high enough. There was too much 'prodding' of the ankle in diagnosis, which was unnecessary. The sending of messages was fair. It was obvious, however, that the text-books had been well studied. An apology for absence from the Minister of Transport was read by Mr. Webb, in which the Minister wished the Association continued success. Sir John Elliott, President of the London Transport Ambulance Centre, also sent apologies for absence. Sir John, he said, had to have an annual holiday like the rest of us, but it was most unfortunate that his holiday happened to coincide with the competitions. The trophies and plaques were then presented to the winning teams by Mr. John Cliff. Mr. Parshall said that he considered it a great honour to be entrusted with the duty of proposing a vote of thanks to Mr. CJiff for consenting to make the presentation. ,His attendance there was an indication of the importance attached to first aid by those in high places. It had been very encouraging to see the skill which had been displayed that day, and he referred to the unique position of the Liverpool women's team. Every member of the team had taken her first certificate only six weeks before the competition, and half-way through their training the secretary had had to alter the names of two of the team upon their marriage! Turning to Mr. Cliff he concluded' Your presence here to-day is an inspiration to us all.'

National Association of Ambulance Officers (No. 5 Region)

AdditiollaI Removal Test in Amhnlanc~ Efficiency Competition AFTER the large number of first aid competitions we have seen on stereotyped lines during the year it was quite refreshing to see something different at the Surrey County Ambulance Training School, New Malden. In addition to the usual first aid test and o ial questions each team, consisting of a driver and attendant, had to demonstrate the removal or a patient, suffering from internal haemorrhage, from his bed to the hospital, a frequent task in the daily routine of any professional ambulance crew. The test was devised and judged by Mr. e. R. Lawrence, Ambulance Controller, Oxford City and County Council. The main test, First Aid, was set and judged by Major A. e. White Knox, O.B.E., M.e., M.B., Ch.B., Principal Medical Officer, St. John Ambulance Association. Mr. P. H. J. Wilkinson, County Ambulance Officer, Northants County Council, set and judged the oral questions. In the main test each crew, consisting of driver and attendant, have been called to a man who has fallen from a brick wall, and is found to be suffering from fractured base of skull, Potts' fracture of left leg and is in coma, which develops into compression. They are expected to diagnose and treat the case, load him into the ambulance and drive off to hospital. In the removal test the patient is lying in a back bedroom and, when the competitors arrive, is found to be vomiting I.' coffee grounds '). The difficulty of removal is increased by the awkwardness of the staircase and loose stair carpet. Presiding at the presentation ceremony, which was held in the grounds, Dr. C. Crowther, Chairman of the Surrey County Council Ambulance Centre and Ambulance Sub-Committee, extended a warm welcome to all present. Of the competition, which had been organized by the National Association of Ambulance Officers (No. 5 Region), for the purpose of encouraging a high standard of efficiency amongst members of local authority ambulance services throughout England and Wales, he felt it to be a splendid idea. There can be few occupations, he said, in which efllciency was more needed. All who have to serve the sick and injured should be as efficient as possible, and he emphasized the importance of constant practice. The work of these ambulance men was done in full view of the publicand the public were, as a rule, very critical. At this stage the results of the competition were announced : -

Marks ].

2. 3. 4.

Buckinghamshire County Council (winning the' Wadham Regional Trophy'). County Borough of Eastbourne (S.J.A.B.) County Borough of Brighton Hampshire County Council

221

208 200 192

5. 6. 7. 8. 9. 10.

Surrey County Council (Guildford S.J.A.B.) Essex County Council London County Council (present holders) East Sussex County Council (Crow borough B.R.C.S.) ... County Borough of Croydon County Borough of Hastings (S.J.A.B.)

191 175 171 168 J 67 165

Alderman Collier, Chairman of Hampshire Health Committee. said that he was particularly impressed with the three last lines of the programme: 'with a view to introducing the best known methods for the benefit of their patients.' He felt sure that those in the ambulance service did not work for trophies and cups, but for the service of man. The chairman then invited the judges to comment upon the tests they had been judging. Major White Knox opened by stating that he had been most interested in the vehicles and equipment which he had seen there that day, for they were magnificent. Tt should be an incentive to those working with them to ensure that their efficiency equalled that of the material with which they were working. Those he had judged that day were not perfect, but by practice they would improve. He emphasized the importance of accurate diagnosis. After that, if they knew their text-books, then nothing could go wrong. It was not necessary to try to master advanced technical works. If they knew their elementary text-books, that was all that was necessary. 'I may have been hard to-day' he said, , but that is what I am here for. My final advice to you is to PRACTICE. ' He expressed the very great pleasure it had given him to come there that day to judge the competition. Mr. Lawrence addressed his remark directly to the members of the teams. 'The case I set' he said, 'is the sort of thing you fellows are called upon to do in the course of your day-to-day work. Sometimes the doctor may give you the details of the case, but it is the removal which is your job, and the method of removal was the part I judged YOll on to-day.' He referred to the loose carpet, which provided a potential danger. Many, he said, would like to have removed it altogether, but they bore in mind that, after completing the removal, the wife would probably have expected them to replace it. They should, also, have laken into account the fact that the patient was suffering from internal haemorrhage, and this should have modified their methods. Each team, he said, had adopted a different method, and it had been very hard to judge between them, for each method had had something to recommend it. The comfort of the patient should have been the principal factor in deciding upon a method, and he had taken this into consideration in assess-

ing the marks. Some had slipped up on details, such as the importance of making certain that the patient was adequately covered before removing the bedclothes. Some forgot the doctor's note and the instructions to the wife as to what the patient shoul~ take w}th him. To sum up, he had found It very difficult to differentiate, for they were so close together. He had thoroughly enjoyed judging his part of the competition that day. Mr. Wilkinson, who had judged the oral questions, stated that he felt that his task had been comparatively simple. The four questions for the drivers were concerned with the Highway Code. He regretted to say that their knowledge of this appeared to be atrocious, and how they had managed to get to the competition ground he did not know. Simple questions like 'What are the signs indicating schools, hospitals, etc. ' had floored some of them, but he could not resist the temptation to tell of the driver who described the 'torch of education' as resembling 'one of those ice-cream cornet things.' Possibly, however, they really knew the answers, and in driving would react automatically to each sign, but in competition, due, perhaps to nervousness, they found it difficult to explain. Like his colleagues, he had found it a great pleasure to be there that day, and he hoped they would not think that he had been too harsh. Divisional Superintendent A. J. Sumpter, the competition secretary, thanked all those who had so willingly assisted him in his task, and he would like, especially, to acknowledge the generosity of the Surrey County Council for having invited them to stage the competitions at their training centre. In thanking the judges he referred especially to Major White Knox, whom he had approached, he admitted, with some misgivings. Major White Knox holds a very high position in the ambulance world, and they felt that it had been most gracious of him to consent to judge the competitions. They were most grateful to all three judges. They also wished to thank the stewards, marshals and ' patients.' With these 1astnamed he had the greatest sympathy, considering all they had gone through. However, they had been well trained by the Casualties Union and had managed to survive the ordeal.

Other Competitions We regret that, owing to pressure on space, we cannot include reports in this issueon the Casualties Union Competitions, Gas Council Final, G .P.O. Final, Sussex Open Final, and the first annual report of the St. John Council for Kent .

FJRST AID & NURSING,

IT was pleasing to see the unifofms or firemen and those of St. John mingling together at the final first aid competitions for Local Authority Fire Brigades at the East Cliff Pavilion, Folkestone, held under the auspices of the St. John Ambulance Association. Eight teams competed, each being the winner in its respective District Competition, and the winner of this Competition represented the Fire Brigades at the Grand Prior's Trophy Competition in November. As soon as the teams had drawn for position the Mayor of Folkestone, CounciUor T. L. E. Franks, J.P., welcomed the visitors in a few well chosen words, and the first team was called in. The Competition had commenced. Each team had to submit to a team test and individual (dual) practical tests, these being judged by Drs. D. D. Towle (team) and D. M. Beaugie (individual). In the team test the team is caUed to attend to a workman who has fallen 35 feet from a scaffolding. Injuries: Fracture of 7th and 8th ribs, which have pierced the liver, haemorrhage from right radial artery, fracture of left fibula and suspected fracture of pelvis. Nos. I and 2 have to attend to a man who has been dragged, unconscious, from a hut in which a coke fire is burning. He is found to have sustained a Potts' fracture. Nos. 3 and 4 find a man wbo has been knocked down, sustaining a gash on the right cheek, a Colles' fracture (right), and is suffering from concussion, obviously the result of a bruise on the forehead. At the presentation ceremony the chair was occupied by Lieut.-Commander J. H. Fordham, C.B.E., R.N. (Retd.), who is Chief officer, Kent Fire Brigades, and he was supported by the Mayor and Mayoress of Folkestone; Mr. Horace F. Parshall, T.D., M.A.(Oxon.), Director-General of the St. John Ambulance Association; Mr. J. Y. Kirkup, M.B.E., Chief Fire Officer, City and County of Bristol; Mr. Chartres and the judges. Many other wellknown personages were to be seen supporting the Competition, of whom we noted Lady Fisher, Mrs. Fordham, Mrs. A. Jay (Area Superintendent, S.J.A.B.), Major Bossom, Mr. G. Eastham, Chief Officer Worcester City Fire Brigade and Secretary of the Chief Fire Officers~ Association, and others. Dr. Towle, who had judged the team test, was the first judge to offer comments. Admitting that the team test had not been an easy one, he pointed out that the training of the first-aider could be divided into three stages, viz., learning the text-book passing the examination and then the reai thing, in which he experienced the actual bloo~ and ~uts. When a patient groans, then It IS qUlte certain that life still remains in the body. Try to find out if he will answer a question. The speaker was pleased to note that most of the competitors realised that the treatment of haemorrhage must come first, but there was '!- correct way to apply compression. Swelling about the ribs should immediately suggest the possibility of internal haemorrhage .. If he yells for air, don't ignore it and tell ~un .to shut up. They could ignore exammatlOn of eyes until the patient is on

his bad, then BOTH pupils should be examined. He reminded the competitors that the fractured pelvis was only 'suspected,' and that this could only be confirmed in hospital by X-ray examination, altbough the' patient' had been made up as well as possible. Altogether the standard of work was good, and was certainly getting better still. 'I have thoroughly enjoyed myself' he conduded, ' and I hope you have.' Dr. Beaugie followed with what he described as some general remarks. He admitted that judging the competitions that day had been one of the most difficult tasks of his life. All had tried hard, but there had been one Of two mistakes, although no glaring ones. Artificial respiration, which was most vital, had been performed extremely well. Those thumps on the back bad, in one or two cases, been rather too vigorous. The conscious patient had not been questioned as much as he might have been. Such questions as , Where does it hurt?' or ' Anything else?' would have been of great value. He referred to one team wbich had had a card typed out already with a phone message to tbe doctor, even to such a detail as . East Cliff Pavilion' where the doctor was wanted. He hardly knew what to say about this. 'I don't diagnose a case before I get to the house' he commented. Referring to the treatment of shock, he reminded them that if blankets were not available there could be no objection to them using their own coats. 'Like Dr. Towle' he said, , I have thoroughly enjoyed my experience. Thank you for inviting me.' At this stage the results were announced by Mr. George Craft, the competition secretary : 1. County Borough of Great Yar361 mouth (winning the St. Jobn the Baptiste Tropby.) 357t 2. City of Cardiff ... 350 3. City of Manchester 332~ 4. County of Surrey

(Top) Left to right : Dr. D. M . Beaugie, J. Y. Kirkup, M .B.E., H. F. Parshall, T.n., M.A., Lt./Comm. J . H. Fordham, C.B.E., R .N. (Ret.), The Mayor of Folkestone, Councillor T. L. E. Franks, J.P., S. H. Charters' and Dr. D. n. Towle.-(Bottom) HoraceF. Parshall presenti ng the cup to the captai n of the winning t~am, FirE.'man C. Aldred.

OYEMBER DECEMBER J955

City of Kingston-upon-Hull 323 City and County of Bristol 3201 3l6~ 7. City of Birmingham 8. County Borough of South Shields 3011With a handshake and a few words of congratulation to each member, Mr. Parshall presented the Trophy to the winning team and individual plaques to the first three teams. He said that this was the fifth Annual Competition for members of Local Authority Fire Brigades for the Trophy and plaques presented by the St. John Ambulance Association, and it had been his pleasure to be present at each one. He had been terrifically well impressed with the enthusiasm he had seen exhibited by the firemen. He enjoyed these competitions, not merely to find who were the best, but because they realised that the whole standard of work was being braced up. The St. John Ambulance Association was aiming at more first aiders and better first aid. Of the many foundations of the Association perhaps the best-known was the Brigade, and it was from the students trained by the Association that the Brigade was recruited. Last year the Association awarded 90,000 new certificates and reexamined 40 odd thousands. He expressed the appreciation of all to the Folkestone Divisions for tbe help they had rendered that day. Mr. Chartres, deputizing for Mr. H. M. Smith, C.B.E., Chief Inspector of Fire Services, read a letter of apology for absence from him, and referred to the great enthusiasm which Mr. Smith had always shown in the work. He always came to all Fire Brigade functions if he possibly could. Mr. Chartres thanked Mr. Craft- ' that very able fellow '- for so successfully organizing the competition that day. The Home Office, he said, wished to thank Mr. Parshall and the St. John Ambulance Association, the President and Chief Officers of the Fire Brigade for 5.

Continued at bottom 0/ next page

FJRST AID &

URSING ,

OVEM BER. DECEMBER 1955

The St. Joint ..-\.111bllla nce Association anti the St,. tJOb11 Ailibulance Brigade

Annual Reports 'What is the difference between the St. John Ambulance Association and the St. John Ambulance Brigade?' How often we hear this question asked, not only by the general public, but frequently by the members themselves, and the indiscriminate use of these titles by the press provides still further evidence of the confusion which exists in the- public mind regarding the respective functions of these two organizations. Both are foundations of the Order of St. John, and are controlled by an Executive Officer appointed by the Grand Prior of the Order: the Director-General in the case of the Association and the Commissioner-in-Chief in the case of the Brigade. Their relationship can best be illustrated by reference to their formation. After its revival in England the Order was not at first clear how to give expression to the objective summed up in the second of its mottoes Pro Utili tate Hom ill lIIl1 , but eventually it was decided to institute training for civilian personnel in what later came to be known as the Principles of First Aid. To carry out this work the Order in 1877 founded the St. John Ambulance Association, and in the following year the Association published its first text-book styled' Aids for Cases of Injuries or Sudden Illness.' Soon after the fom1ation of the Association, a strong desire arose on the part of Certificate holders to put their knowledge to regular use and to maintain their efficiency. This desire led to the formation of Ambulance Corps of the Association, and in 1887 these Corps were banded together in the St. John Ambulance Brigade. The Brigade, whilst preserving its independence as a separate command, remained under the overall responsibility of the Director of the Ambulance Department, but in 1948 the Brigade became a separate Foundation of the Order. The primary object of the St. John Ambulance Association is the instruction of persons in First Aid, Home ursing, Hygiene, Food Hygiene and Child Welfare, and to this end it organizes classes of instruction, examinations and re-examinations in these subjects. The Association issues Certificates to successful candidates at its examinations, and awards for subsequent re-examinations, e.g., Vouchers, Medallions and Labels for First Aid and Pendants for Home Nursing. The Association also publishes text-books on these subjects which are translated into many foreign languages.

The primary object of the Brigade is to train and maintain a body of men and women and boys and girls thoroughly efficient in First Aid and Auxiliary Nursing so as to combine individual efforts in the service of the public. Those who join its ranks give their services voluntarily and gratuitously and wear uniform so that they can be easily recognised in case of emergency whilst on public duty. As the qualification for joining the Brigade is the possession of a First Aid Certificate (and a Nursing Certificate in the case of Nursing divisions), it will be seen that the activities of both these Departments of the Order are clo~ely related and complementary to each other. The Association, therefore, is the training, or educational Department of the Order. It publishes its text-books, arranges instruction and trains as many students as possible, both at home and overseas. The Brigade, on the other hand, is operational and draws its members from those who obtain Association Certificates. Last year the Association issued 85,115 Certificates to candidates successful in examinations in England and Northern Ireland, bringing the total to 3,817,956 since the date of its foundation. In addition 170,OQO were issued to candidates overseas in 1954. The total number of Certificates issued by the Association since 1877 at home and overseas now amounts to 7,215,022. While only a small proportion of those gaining Certificates join the Brigade, Nevertheless, the strength of the Brigade is steadily growing. The Association has not been slow to take advantage of modern techniques to promote the teaching of the various subjects forming its curriculum. The Principal Medical Officer, Major A. C. White Knox, O.B.E., M.e., M.B., Ch.B., has made a film on Artificial Respiration, illustrating the various methods which are taught by the Association. Anatomy is being taught by means of ftannelgraphs, and these will shortly be available from the Stores Department at a very reasonable price. The world-wide demand for instruction in these subjects is being met rapidly, and the various text-books published by the Association have been translated into Arabic, Turkish, Marathi (India), Chinese and many other languages. Centres of the Association are to be found all over the world, recent formations including Nigeria, the Gold Coast, Cyprus, the West Indies and the Leeward Islands, the Windward

Islands, Grenada , British Honduras, Malaya and the Sudan. Other centres which have shown progress during the year are orth. Borneo, Mauritius, Aden, British Somahland and Beirut. It is very gratifying to note the progress being made in the competition world, and we are very pleased to see the rapid increase in the number of organizations which are now sending teams. Perhaps we might take this opportunity of explaining that, whilst for this reason it will be necessary in future to curtail our reports of the major competitions, we shall endeavour to retain those features which we consider of vital importance to students, viz .. outlines of the tests, the judges' criticisms and our own comments ' From a Seat in the Audience .' The Brigade Report opens ~itb an announcement of 125 new Adult Divisions and 157 new Cadet Divisions. We are particularly pleased with the latter as it is to these young people that we look to carry on the work when we have passed over. Although it is inevitable that some divisions may, for various reasons, have been unable to continue, an overall increase of 69 divisions and 4,605 personnel is shown over the previous year. That the Brigade is by no means a paper one is shown by the fact that during the year members carried out a total of 2,094,837 hours on public duty, 1,060.157 hours on transport duties and 377,468 hours on hospital du ties. In addition to these there were attenda nces at clinics, nurseries, blood-transfusion sessions, nursing aid and many others too numerous to mention separately. During the year the Commissioner-inChief made a most successful tour of divisions overseas, when he visited Bermuda the Bahamas, Jamaica, Trinidad, Grenada, Tobago, British Guiana and Barbados, at each of which he recei ed a most enthusiastic welcome. The National Hospital Service Reserye depends for its life-blood upon the voluntary services, and during 1954 the Brigade contributed 2,775 new auxiliaries .

their contributions to the success of the event. Mr. J. Y. Kirkup, M.B.E., President of the Chief Fire Officers' Association, and Chief Fire Officer, City and County of Bristol, said that they had never before seen so many St. John members at one of their competitions, and they were pleased

to welcome them. The object of these competitions was to promote and stimulate interest in first aid. There were many he would like to thank, but he must content himself with mentioning the names of the Mayor and Mayoress of Folkestone, the judges, Lady Fisher, Mr. John Tennant, T.D., O.SU., County Director for Kent,

Miss MacGwire, Maj.-General Hornby and Major Bossom and his staff. headed by Mr. A. E. Campbell, G.M . chief steward, the' patients' and the Casualties Union by whom they were trained. This, in the form of a vote of thanks, brought to a close most enjoyable and successful a event.

It only remains for First Aid alld Nursing to congratulate those two grand personalities, Mr. Horace F. Parshall, T.D .. M.A.(Oxon.), the Director-General of the Association, and Lt.-General Sir Otto Lund. K.e.B., D.S.O., the Commissioner-inChief of the Brigade, upon their most encouraging Reports, and to wish them continued success.

FlRST AID & NURSING, NOVEMBER/ DECEMBER 1955

From a seat in the audienee

FIRST AID & NURSING, NOVEMBER ,DECEMBER 1955

* First-Aider~s Crossmord No. 20

The Repair

Compiled by W. A. Potter

National Road Passenger Transport One spoonful of sugar-hardly 'very sweet.' , Grannies' galore. Unconsciousness must be the first consideration. A wet dressing is not a cold compress. Don't ignore the policeman! Too much delay in releasing the victim. Binding should have been more realistic. It was totally ignored by some competitors until afterwards, when it was found to be in the way of treatment. We saw a suspected fracture palpated with the BACK of the hand, and over clothing! Loose bandages constituted a common fault throughout. The' patients' were good, especially in relaxing muscles. This requires some training. Could they not see that he was a policeman? Was it necessary to give the policeman a lesson in first aid? No blankets! They had jackets on, hadn't they? Hot water bottles were not asked for until near the end of the test. Now, Captain, make up your mind. What did you really want done? National Association of Ambulance Officers Competition Why collect stretcher and material before attending to patient ? , Too many unnecessary questions. The " patients " were well "faked.'" Significance of blood from ear was often not appreciated. Few noted the character of the vomit (' coffee-grounds '). Could they not wait until certain that vomiting had ceased? How noisily one team ascended those stairs. Why not stand on the opposite side of patient to place the rolled sheet? There was plenty of room. You cannot take a pulse in 10 seconds. Handling of patient in most cases indicated inexperience. Much of the diagnosis was guesswork. Not all teams applied traction. We hope the chest of drawers was not damaged when hit by the patient's head. Not many realized that the wife could assist in lifting. Backed vehicle whilst attendant was opening the doors- ' Safety first.' What is the use of applying traction if it is released before the Iimb is secured ? Why will teams go for fractures and ignore the general condition of the patient? 'Is there any RESTR[CTION on the chest? ' Fire Brigades Competitions Making-up in view of the audience is to be commended, but a few words of explanation would have made it more intertesting. Why test only one end of the stretcher? You can't test hot-water bottles over your sleeve.

Continlled at the bollom of page 12

Squad When you receive a wound or a burn, your body mobilizes its repair squad to make good the damage. Infection by bacteria hinders th e repair squad in its work and may even overwhelm it, so that the wound heals slowly or not at all.

infection must b e prevcnted or suppressed, and this some of the oldcr antiseptics do quite effectively. But no antiseptic, however efficient, will hcal a wound; only the r epair squad can do that. The drawback of the older antiseptics, such as acriflavine, tincture of iodine, propamidine, etc ., is that they interfere with the repair squad's activities -

and thus thcms ehes slow down the process of

healing. C

Furacin " however, is an entirely new type of germicide, whjch destroys bacteria and prevents

ACROSS 1. Queer Scholar Indicates Serious Eye Damage (9,5) 7. Animal found in scalp and Axilla ... (5) 8. Sensation may be lost after its bite (5) 9. Applied in inflammatory conditions (4) 11. Open (5) 13. Anaesthetic makes three (5) 14. Sounds informative to the doctor (5) 15. Wood-appears bony (5) 17. Visual topic (5) 18. Cause upset-for goose and gander (5) 19. Convulsion for which a patient may ask his doctor ... (5) 20. Filled in the waiting hall or at Sister's desk ... (5) 22. Must be live for efficient sterilisation (5) 23. A mechanical power ... (5)

24. 26. 27. 28. 29.

Hatred... Germ of progress A new one is proverbially efficient . .. For skin sutures Blessed leg vein torn. Pressure is indicated

(5) (4)

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the ·wound.

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For this reason, C Furacin ' is becoming more and more widely used in hospitals and first-aid

DOWN 1. Mischievous spirit begins to get better (7) 2. Siren makes wash out (5) 3. Tissue transplant (5) 4. Carefree with cardiac atrophy? (5,7) 5. Relatively mild enteric fever. .. (11) 6. Antiseptic technique ... (9) 10. Acme of nausea (2,4,2, I ,3,) 12, Discharging skin lesion-or athlete's blister? (7,4) 16. Usually 7th, 8th, or 9th (6,3) 21. Variation of male sin ... (7) 24. Animal of 480 grains ? (5) 25. Briti sh, Canary, or Channel (5)

SOLUTION TO CROSSWORD No. 19 ACROSS 1, Ages; 7, Bulb; 10, Parasite; II, Asti; ]2, Acme; 13, Catching; ]4, Rota; 16, Enid; 17, Chats; 19, Alibi; 20, Duncan ; 21, Gas; 22, Sprain ; 2.3, Stoic; 24, Lamps; 26, Rude; 28, A SIP; 30, Pathogen; 31, Nail; 32, Gape 33, Anaerobe; 34, Eyes; 35, Rays.

infection outstandingly well, and yet leaves the

DOWN 2, Gusto; 3, Spica; 4, Crutch; 5, As white as a sheet; 6, Stone; 8, Unconscious; 9, Bleeding cup; 14, Reassurance; 15, Thin red line; 17, Civil; 18, Guess; 25, Pigeon; 27, Faint; 28, Anger; 29, Imply.

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queries Answered by Dr. A. D. Belilios A . G . B. (Bournemouth) writes :R ecenllr I heard of an unusual emergen(v in which a child fi11ed its mouth 1I'ilh an effervescent pOll'der and began to ha ve difficult)' in breathing as the p owder gave off its gas. Bubbles of gas even appeared at the nose. What first aid 1V0uld y ou recommend for such an acc;dent.

Answer I am always pleased to hear of unusual accidents; let us ha ve some more. I wo uld suggest forcibly open ing the mouth using an improvised gag if necessary and then removing as much of the effervescent powder as p o ss i~le. This is not easy and the gag is desirable to prevent the first-aider from being bitten. T he child should be encouraged to spit out and if vomiting occurs, removal of the ca use is thereby assisted. Otherwise the treatment should be as fo r threatened asphyxia. M . M. S. (Exeter) writes :The pain of a dislocation is described in the S.l. A.A . manual as being of a severe sick ening character. r lI'onder (frou could explain, please, II'hy it is ' sickening' in character.

Answer A dislocation is always accompa nied by shock and nausea and vo miting may result from this cause. In addition the displaced bones may press on nerves near the joint altering the characteristics of the pain. S. E. H . (G lo ucester) writes : f am allva)'s very nervous when tak ing an examination . One of my f riends has advised m e to have a cup of hot STrong coffee about ha(f an hour before I go in. Before doing so, ho wever, j thought I would like to enquire through ),our valuable columns whether this is a good preventative.

Answer No, coliee is a stimulant and might even make you more nervous than before. I t is, however, valuable if you want to make your brain work a little more quickly and you possess the knowledge but have difficulty in getting it out. There are drugs, of course, which can be given in cases like yours but it is better to avoid them. With more experience your , nerves' will become less troublesome and you will actually enjoy examinations! J. B. (Watford) writes I have a friend II'ho suffers from A sthma. She gets allful attacks at times and these rna) ' even last for da)'s, with onl), sligh"t relief obtaiiled from the drugs her doctor gives her. -I wonder if Dr. Belilios can kind~) ' explain the cause of this most unpleasant complaint and suggest any remedies that my friend can tr),.

Answer Not so easy! There are many causes of asthma and sometimes these are combined. First of all, a tendency to allergic diseases may be inherited. Secondly the patient may be allergic to one or. more of many different substances such as dusts , foods , plants etc. Some cases are associated with an infection with germs while others without doubt have a nervous background. So far as remedies are concerned this is a matter for the doctor in charge of your friend 's case and depends upon the causes. P. McA. (Epsom) writes Although I am only a nell'comer to first aid, a few weeks ago I helped when a sma11 motor car turned over after a collision. There was a smell of petrol and I told the driver to turn of]' his ignition. By this time others arrived and we managed to turn the car upright. These others, however, promptly hfted the motorist out of his car and made him sit on a horse trough near-by . It was a cold and wet night. Would it not have been better to have kept him in his car until the ambulance arrived?

Answer The smell of petrol suggests the danger of fire and although the risk may have been small, it was not worth running. Hence [ would agree with the patient being removed

URsr G ,

OVEMBER DECEMBER 1955

FIRST AID & NURSING,

OVEMBER DECEMBER 1955

taking care to support injured parts and then treating the shock i neluding protection fro III the cl ement . II doe n't sound from your descriptiOll that the latter part of the first aid was well carried out.

STRETCHERS

E. D. T. (Penzance) writes : S everal of us have been having an argument and we would like Dr. Belilios' opinion please. We cannot agree on the reasons for putting a chdd 1I'ho is having il?fantile convulsions ill a bath of hot water and k eeping a cold sponge 017 the top of its head.

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Answer I can quite understand your difficulty in understanding the reasons for the treatment which , incidentally, is not easy to carry out. Tn theory, the hot bath should draw blood away from the head and the cold compress act similarly by decreasing the blood supply to the head and brain. But I myself am very sceptical about the value of the treatment and would far prefer to see the child put to bed and treated on general principles until the doctor arrives. J. B. B. (Leicester) writes :Is there a suitable antidote that can be applied to the skin in the event of splashing It'ith carbolic acid?

Answer If readily available, methylated spirit can be used to mop off the acid; failing this, the general princi pIes for burns caused by corrosive chemicals must be applied.

From a Seat in the Audience One rapid exa mination of a p atient we saw would disclose nothing . Don ' t interrupt the rhythm of A .R . to ask questions . No teaspoon with which to test for swa llowing- Moi sten your fingers, if clea n. ' I will wash my h ands a nd scrub my nails ' -but he didn ' t. , Like a dinner-fork .' Was not this too obvious a clue ? A cup of tea placed on th e Roor might get kicked over'. Cups of tea were sometimes prepa reda nd then forgotten ! The cold compress (3 pa rts to I) should be actually prepared . ' Is he consciou s?' The p atient was ta lking all the time. One competitor thanked everyone for assistance rendered. Thi s was realism indeed. Get on with it. The patient's losing blood all the time you are explaining. Don ' t emphasize your rem a rks by pressing on the patient's abdomen.

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FIRST AID & NURSING, NOVEMBER /DECEMBER 1955

FIRST AI D & NUR SING, NOVEMBER; DECEMBER 1955

Miscellaneous Advertisements Advertisements with remittance shou ld be sent

OBITUARY Captain A. N. Cahusac It is with regret that we announce the death of Captain A. N. Cahusac, O.B.E., M.e, who died on 14th November. He was appointed Chief Secretary of the St. John Ambulance Association on 18th January, 1918. He retired from this p.ost in September, 1953, after 35 years serVlce.

Beatrice M. Hossack Ipswich has lost a well known worker in the ambulance cause by the death of Miss Beatrice M. Hossack who died on October 20th. She was the daughter of the late Alderman Dr. J. F. e Hossack, F.R.C.S. who was the Commissioner of the now extinct No. 10 District of the St. John Ambulance Brigade. Her activities for the good of mankind were many and various. A member of the St. John Suffolk Council, a member of the Ipswich Town Council, Chairman of the Suffolk County Women's Section of the British Legion, a member of the Management Committee of the Nayland British Legion Sanatorium together with Committees of the Town Council on Children, Health, Civil D efence and Museum is not to name all with which she was connected . The funeral at the Tower Church on October 24th was attended by a congregation of over 550, including a civic procession of 62 led by the Mayor of the Borough (Alderman C. G. Rushen). Representatives of the St. John Ambulance Brigade included: Major Schreiber (County Commissioner), Lady Blanche Cobbold (County President), Mr. B. J. Reid (representing the Earl of Cranbrook, Chairman of the Suffolk St. John Council) and all local, area, and Suffolk officials of the Brigade.

He was known to people throughout the world as a courteous and kindly adviser in all matters pertaining to First Aid, Home Nursing and kindred subjects. He had a fund of knowledge built up by personal experience over the years and his advice was sought and accepted as authentic. He was Chairman of many Revision Committees of St. John Ambulance Association text books and he was also the Editor of most of the new publications brought out by the Association during the time that he was Chief Secretary. At the 3rd International Congress of First Aid and Life Saving at Amsterdam in 1926 he contributed a paper covering the subjects for which he was the Association delegate. He gave a service to the St. John Amblllance Association which will leave an impression for generations to come.

Every first-aider should own this valuable pocket encyclopaedia (siLe 5t" x 3f' x i", with 514 pages, printed on special thin paper).

For example, under

the heading Fractures, details of the signs and symptoms of all kinds of fracture are given, with diagrams, and a reference made

l!!~~~~~!!!!!!!~~!!!J

B AI LLIER E'S NU R SES' MEDIC AL DI CT IO NA R Y Thirteenth Edition Revised by

to the appropriate appendix in the book where first-aid treatment for fractures is given.

Margaret Hitch S. R .N.

Among the 21 Appendices, those

on first-aid treatment, poisoning, antiseptics, food values and preparation foi:

formerly Sister Tutor

for which I enclose remittance oj

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THE

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Nineteenth Edition. Completely revised 261 st thousand 286 pp., 286 illustrations, some coloured, 65. 6d., post 4d.

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To sufferers from this complaint and ass o ciated disorders comes welcome news of an inex pensive everyday remedy, hitherto only available in costly ca psule fo rm. RUTIN -'T' is made from the d r ied leaf and flowe r of Bu ck Wh e at, which is the source of precious Rut i~, and is at last rea ~ ily and cheaply obtainable. Developed In the U.S.A. during the war it was found to strengthen the blood vessels and wa~ used to counteract internal haemorrhage caused by contact with atomic radiation. RUTIN -'T' utilises the natural properties of the plant , for both preven tion and treatment of hypertension (High Blood ~ressu.re) and it retains othe r beneficial substances including Chlorophyll, which are refined out of p harmaceutica~ Rutin. RUTIN-'T' acts as a pre ventive, delays the effects 0, advancing years and is a health-promoting tonic. PRICES RUTIVITE TABLETS in tins, 1 month 's supply RUTIN-'T' in cartons for 1 month's supply RUTIN·'T' in cartons for 2 month's supply Above prices include Postage and Purchase Tax (U.S. and Canada I Dollar and S I 75, other countries 6/· & 11 /6 post free)

TO THE !NJURED AND SICK Edited by A. P. GORHAM, M.B., Ch.B., M.R.C.S.

Police Surgeon, City and County of Bristol

'FIRST AID' WALL DIAGRAMS 26 X 40 in.

A The Gear illustrated (A. B.C.D.) carries two stretche rs on one side of Ambulance, leaving other side clear for sitting patients.

METHODS OF ARnFlCIAl RESPIRATION

A- G Anatomy and physiology . H- J The triangular bandage . K, L The roller bandage. M. N Hzmorrhageand wounds . 0, P Dislocations and fractures . Q, R Transport. S, T Artificial respiration .

The UP AND DOWN action is q1Jick and easy for load ing or unload ing. A. Shows the two stretchers in position. B. Shows t he top stretcher lower ed ready for loading.

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

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Full catalogue of Ambu lance Equipment No.7 A w ill be sent on request .

MEN'S UNIFORMS and LADIES~ GREAT COATS & COSTUMES for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

D. S hows the same position as in I f C ' only with cushions and back r est fi t ted for conValescen t cases.

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JANUARY/FEBRUARY 1956

The design provides for two stretchers and an attendant, one stretcher and three sitting cases, or six sitting cases. Features include built-in wash basin with water supply, fully insulated body , for tropical use, and adequate locker accommodation. You are invited to apply for full details of Mobile Medical Units, Ambulances, etc., built to your particular requirements for service in any part of the world.

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bactericidal thus obviating the need, when not convenient, of changing the dressings ~very day. fOR CUTS, ABRASIONS, BOILS and numerous skin infections, ANTIPEOL is unquestionably the remedy. It is already in widespread use by the medical and nursing professions in many parts of the world . ANTIPEOL is therefore an essential componen t of 'every First Aid and Nursing Kit.

antipeol cutaneous ointment Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTlPEOL for nasopharynx infections; OPHTHALMO-ANTIPEOL for ocular infections; DETENSYL for reducing arterial tension. MEDICO-BIOLOGICAL LABORATORIES LTD .. CARGREEN RD., SOUTH NORWOOD, S.E.2S

Printed by HOWARD , J ONES, ROBERTS & LEETE, Ltd .•.26·~8 Bury Street, St. Mary Axe, London, E.C.3, and published by the Pro;:>netors, DALE, REYNOLDS & Co ., Ltd., at 32 Fmsbury Square. London, E.C.2, to whom all communications should be addreSsed.

FIR ST AID & NURSING, JANUARY/FEBRUARY 1956

Lomas "B type" ambulance

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Editor : Peter I. Craddock This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.C.2, for the purpose of providing an informative technical service on first aid and nursing. We welcome contributions.

Jan~ary/February

1956

In this Issue

It pays to staridardise on

Bedford Day in, day out Bedfords brilliantly perform all the varied transport tasks of public authorities. No other range of vehicles has such a high reputation for reliability and economy. Modernly designed Bedfords form the ideal 'one-make' fleet; they pay in el'ery way! 'Onemake' transport means greatly simplified maintenance and spare part stocking. To this add the extra Bedford advantages oflow first cost,

low upkeep cost, low-priced readily available replacements, and Square Deal Service from 520 authorised Bedford dealers. With a range of chassis covering all loads from 10 cwt. to 10 tons, there is a Bedford for every local government needyou see them everywhere. Full particulars from your local Bedford dealer, or wri te direct to the Municipal Vehicle Department, Vauxhall Motors Limited, Luton, Beds.

fOR EYERY LOCAL GOVERNMENT NEED

Fire Appliances from £1 ,736

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Meritorious F. A. Rendered by Signalman Improvement in Insensibility Treatment 1 Poisons 2 Casualties Union Competitions 4 The Order in Kent 5 Collapse Therapy Used in Pulmonary Tuberculosis 6 7 Gas Industry F, A. Finals G. P. O. Finals 8 Obituary 8 London Transport Ambulance Centre 10 Sussex Open Competition 10 From a Seat in the Audience 12 First-aider's Crossword 12 Readers' Queries 14

Meritorious First Aid Be"de r ed by Sig"alma" THE value of ambulance training on British Railways cannot be better demonstrated than the case in which John T. Yeats, a Signalman of the Operating Departl!1ent, Blaydon, Newcastle, gave almost Instant attention to Hector Flatman a Freight Guard of the Operating Depart~ ment, Newcastle. Below is the citation which describes how the attention received by Flatman when Flatman tried to board his Guard's van at the rear of his train fell and had his legs severed most cert~inly sa ved his life:' , At about 1.10 p.m., Signalman Yeats was watching from his signal cabin the passage of the Victoria Garesfield to Addison mineral train on the Down Branch line when he noticed Guard Flatman try to board the rear end of the guard's van of the train. He failed to do so and was noticed to roll over and hold his legs raised having been injured about the legs. 'Yeats promptly collected the First Aid box and ran to the scene of the accident having to cross a roadway and set of lines to reach the patient. As he left the signal box he asked Signalman Taylor who was on duty in the same box to call a Doctor and an ambulance. 'On examination the patient was found to have both legs almost severed, the feet and parts of his legs held only by skin at the back. He immediately placed constrictions (folded bandages) above each knee and with the assistance of a bystander moved the patient into shade. The legs were raised by placing the Guard's bag under the knees. Not being satisfied about the bleeding he placed impro vised tourniquets on both femoral arteries and then proceeded to cover the wounded ends of the legs with lint, cotton wool and triangular bandages. Shock was treated, the patient given a dose of Sal Volatile and a stretcher obtained. The patient was placed on the stretcher with the assistance of the bystander and a member of the constabulary and carried to the road as

the ambulance and Doctor arrived. The Docto~ gave the p.atient an injection of mO!"phla to ease hiS extreme pain. The patient was then loaded in the ambulance and conveyed to Newcastle Royal Infirmary, accompanied by Mr. Yeats and the Constable.' The opinion of the Doctor who was called to the accident is given below;, The First Aid treatment in the case of Hector ~l<l:tman was excellent throughout, and. It IS largely owing to the prompt and satisfactory attention he received that he survived his shocking injuries. Arrest of haemorrhage was complete and lC?cal attention was as satisfactory as the circumstances would allow. Attention to the injured man's personal comfort was eminently satisfactory-all that was necessary when I arrived was an injection of morphia to ease his extreme pain.' Mr. Yeats passed his 22nd First Aid examination in March, 1955. It is to men such as him that his colleagues look to for assistance when Doctors are not available and he sets a fine example in promptitude.

A. P. Hunter, Chief Operating Superintendent, North Eastern Region, British Railways, York, presenting to Mr. Yeats at Newcastle, a framed certificate regarding his action. Left to right: E. E. Cowell, District Operating Superintendent, Newcastle. A. P, Hunter, Chief Operating Superintendent, North Eastern Region, Mrs. Yeats, Mr. Yeats. F. R. CharIton, Regional Secretary, British Railways Ambulance Centre.

no you Bedford Scammell Tractors from £713 plus £152.1.4 P .T .

Vans from (410 plus £74 .18.9 P.T .

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that .. • The condition of fever is seldom due to accident? The optic nerves were first discovered by Alcmaeon, an anatomist of Croton, who also recognized the brain as the central organ of sensation? It is most essential to differentiate between , blue' and ' white' asphyxia? The instrument with which the doctor measures your blood-pressure is called a sphygmomanometer? Tea is brewed by the Chinese by pouring boiling water over the tea-leaves and allowing them to stand for only a few seconds, as in this way its aromatic and stimulant properties are obtained whilst extracting a minimum of tannin? The manufacture of soap was first described by Pliny the Elder (23-79 A.D.), who refers to the soft potash soap being hardened by treatment with salt?

Improvement in Insensibility Recently some First Aid Textbooks have been criticized for their recommended treatment of 'Insensibility' and the Neuro Surgeons have very kindly advised as to improvement in this treatment. The St. John Ambulance Association has accepted their ruling and has issued to its members a Supplement to their textbook 'First Aid to the Injured' giving the revised treatment. The essential point made is the great danger of pneumonia due to the inhalation of secretions, blood or vomit into the respiratory passages and the treatment now includes the following rules:1. If breathing is obstructed in any way by blood, secretions or vomited matter, lay

Treatment

the patient on his side in the threequarters prone position (half-way between side and face down position) and ensure that the throat and lungs are free from obstruction. 2. Support the patient in this position with a pad in front of the chest. If no pad is available, draw up the patient's upper knee. 3. If there is still any tendency to choke, the patient should be placed in the full prone position with the head lower than the feet and turned to one side. 4. Keep a continuous and careful watch on the patient. See' Two New Supplements' on page 3.

FIRST AID & NURSING, JANUARY/FEBRUARY 1956

A Course in Elementary First Aid be thought that there is I T may something distasteful about the study of poisoning ! Yet it is a fascinating and important branch of first aid. A poison is any substance liable to cause harm to the human body, injuring health and perhaps endangering life. It may act externally, e.g. on the skin, a not uncommon occurrence in factories where chemicals are used for industrial purposes. In first aid, however, poisoning usually means that the harmful substance has been introduced into the body itself. It may then damage the organs with which it comes into contact, e.g. those of the digestive system or, after absorption into the bloodstream, other organs and systems of the body to which blood is distributed. Poisons can enter the body by the mouth, the breathing system or the skin. The mouth is a common route in the accidental and suicidal cases. Thus a patient may take an overdose of sleeping tablets, a child may drink a potent linctus intended only for adults, while poisonous berries or toadstools may also be ingested. By the respiratory system are inhaled a number of poisonous gases such as carbon monoxide, prussic acid fumes, trichlorethylene, etc., while through the skin by injection by a syringe, various drugs may enter the body, e.g. an overdoE'e of insulin. Distinction must be made between acute and chronic cases of poisoning. In the former, symptoms and signs appear suddenly and progress rapidly as in the accidental, suicidal or homicidal examples. Chronic cases which develop gradually and are persistent, are most common in industry. Workers using chemicals such as mercury, lead, arsenic, etc., may receive repeated small doses of the harmful substance either by the inhalation of fumes or dust or through the frequent swallowing, again in small doses, of the poisonous chemical.

Poisons By A. D. Belilios M.B.) B.S. (Lond.), D.P.H. (Eng.) It is not intended to discuss further in this article the subject of industrial poisoning. First-aiders who undertake duty in factories must make themselves familiar with the chem:icals which are in use, the risks and early signs of cases of poisoning. This month, however, we are concerned with the acute cases of poisoning and must now discuss some of the general principles of treatment which can be conveniently considered under the headings (1) Administrative, (2) Treatment of the patient. Administrative Treatment _ Medical Assistance. It must be appreciated by a11 first-aiders that medical measures are infinitely superior to those that can be undertaken in first aid. But these measures, even when practised by a doctor, are best carried out in hospital where all possible facilities are to hand. The best procedure, therefore, is to dial 999 and arrange for speedy removal of the patient. In the interval that elapses before the arrival of ,:n ambulance the patient himself must receive treatment and this must be continued even during the journey to hospital. The first aid movement, it will be understood, caters for emergencies the world over and circumstances vary in individual cases. Thus in country districts when there may be delay in obtaining an ambulance, it may be quicker to obtain a doctor, while in other areas, neither can be readily secured hence every firstaider must be prepared if need be, to deal with a case entirely on his own. Identification of the poison. It will often be possible to identify the poison that has been taken and this, of course, is most desirable in order that the appropriate treatment can be given. Nevertheless, difficulty may be experienced, for example, when a first-aider finds near a patient an empty pill box which has contained tablets or a bottle of medicine half or totally consumed. Generally the name and address and

telephone number of the pharmacist who has supplied the medicine will be found on the label together with a reference number. Communication with the chemist may be invaluable for not only can he trace the nature of the drug that he has supplied but he will also be able to give useful hints on first aid treatment. All chemists, for example, possess books of reference which give the antidotes of even the uncommon poisons. Preservation of clues. In the absence of concrete evidence of the poison that has been taken, any clue which may lead to its identification should be preserved for the doctor or taken to hospital with the patient. Clues may include an empty glass from which a patient has drunk, the bottle from which a liquid was obtained, samples of vomit, excreta or even soiled linen which has been stained by the juice of berries, etc. If food is suspected, it must be similarly preserved. It should not be presumed that one poison only is responsible for the patient's condition. In a recent case of attempted suicide, clues included a bottle of liniment, a hypodermic syringe and another bottle with its label defaced. The liniment was found to contain belladonna, and the second bottle was suspected to have contained insulin. A blood test was necessary to prove insulin poisoning, the symptoms of which were com- . bined with those of belladonna. Treatment of the Patient The three main objects of first aid are (1) in the case of a swallowed poison, to remove it, as far as possible, from the digestive system before it causes extensive damage and is absorbed (2) to neutralize its action by giving an antidote if such exists and (3) to counteract its effect on the body as a whole. Removal of the poison. This involves giving an emetic except in cases when the patient is partially or entirely unconscious or when staining of the mouth and tongue suggest that a corrosive poison has

FIRST AID & NURSING, JANUARY/FEBRUARY 1956

been taken. There are important reasons for these exceptions. Producing vomiting in an unconscious patient may result in asphyxia through the emetic or the vomited material passing into the air passages. The strain caused by vomiting in a patient whose stomach may have been partially destroyed by a corrosive may result in the organ perforating (becoming punctured) and through this perforation, the complication known as peritonitis may arise. Useful emetics are common salttwo tablespoonsful dissolved in a tumblerful of lukewarm water, or mustard - one tablespoonful similarly dissolved. There are many other emetics such as ipecachuana wine but they are not usually to hand when required. Whichever is given, the dose should be followed by copious draughts of warm water which will dilute the poison, aid vomiting and wash out the stomach. If the emetic fails to act, it should be repeated every five minutes and vomiting encouraged by the firstaider placing two fingers down the throat. Doctors, of course, wash out the stomach rather than rely on emetics but this involves the use of special apparatus and skill only acquired by .experience. When all vomiting has ceased, it is sometimes desirable to give an aperient in order to remove from the

Forthcoming Events Police National Competition at Porchester Halls, Bayswater, on 23rd February. British Electricity Competition at Porchester Halls, Bayswater, on 28th March. National Dock Labour Board Competition at Toynbee Hall, Commercial Street, E.1., on 7th April. B.T.C. (Railways and Docks) and B.T.C. Police Competitions, at Central Hall, Westminster, on 7th June. Ministry of Supply Competition at Central Hall, Westminster, on 22nd June. National Road Passenger Transport Competition at Aldenham, on 1st or 8th July. National Fire Brigades Competition at Hastings, on 28th September.

bowel poison which may have passed into the intestines before the emetic has worked and also poison which may have been excreted into the bowel after having been absorbed into the bloodstream. Examples of the value of an aperient will be given later but whatever the case, whenever possible, the sanction of a doctor should first be obtained. Antidotes. These are substances which counteract the harmful effects of poisons. They act in various Some combine with the ways. poison and convert it into a harmless substance; others prevent absorption into the blood stream. Sometimes it is possible to give an antidote which is itself absorbed and exerts its beneficial action while circulating in the blood. It is very difficult for a first-aider to remember the various antidotes and their dosage hence antidote tables have been produced. But often the remedies are not to hand when required III an emergency while some have to be given by injection-a procedure beyond the scope of first aid. Counteracting the effects. In many cases of poisoning, there is severe shock which must be treated by the usual methods so far as applicable. Other poisons have a depressant (lowering) action on the vital systems of the body. Thus opium and other narcotics may so d~press the respiratory function that artificial respiration may become necessary.

The corrosive or irritant effect that many poisons exert on the organs of the digestive system can be counteracted by giving soothing drinks called demulcents. These include oil and salad oils, liquid paraffin, barley water, gruel and milk. Varieties of Poisons Poisons can be classified in several ways and it is a modern tendency to simplify the classification as far as possible. Nevertheless, if the firstaider is willing to devote a little more time to the study of this subject, the method adopted in these articles will be found helpful. (a) Corrosive poisons are those which burn the parts of the body with which they come into contact. They are strong acids and alkalis. Naturally their chief action when swallowed is on the digestive organs. (b) Irritant poisons. These, as their name implies, irritate the organs and cause inflammation. They include the metallic poisons, bad food, fungi and berries. (c) Narcotic poisons. These act on the nervous system after absorption into the blood producing a tendency to sleep. They will be more fully described in a subsequent article since they form a very important group of poisons in modern life. (d) Deliriant poisons which also act on the nervous system producing a condition resembling delirium. (e) Convulsant poisons which act on the nervous system causing fits.

T'f)O New Suppleu.el,ts Two Amendments to the 40th Edition of the S.J.A.A. First Aid text-book have just been passed to us, both containing much useful up-to-date information. Supplement No.2 is introduced in order to bring the sixth lecture into line with Civil Defence teachjngs, and deals with the treatment of burns in modern warfare, especially phosphorus bmns. It has long been noted that few of the standard text-books on First Aid mention this particular type of burn, which, in view of its peculiar nature, demands special treatment. Blast is also dealt with in this pamphlet which, however, will not be included in the standard syllabus of instruction and examination for the Association's Certificates. The tabular form in which the standard casualty symbols are presented facilitate memorizing. Supplement No.3, on the other hand, is intended to supersede some earlier teachings

on Insensibility, Fractured Skull and Concussion and Compression. Would it not be an advantage if the actual procedure of 'ensuring that the throat and lungs are free from obstruction' were explained ? We note, also, that if the patj~nt is on _a stretcher the foot should be raised to dram secretions from the lungs. Whether or not gravity can assist in this has long been a debatable point, for the lungs canno.t be drained mechanically, and the bronchI are not likely to be obstructed. However, no harm can be done by attempting posture drainage. The new instructions for the treatment of Concussion and Compression respectively will put an end to those heated discussions we have frequently heard at the Competitions. The leaflets are well worth the twopence each charged for them.

FIRST AID & NURSING, JANUARY/FEBRUARY 1956

Casualties lJnion Competitions Ti,e BuxtOll Trop/'y does the modesty .of the Cas~alti.es WHYUnion still compel It to descnbe Its Annual Event as merely a ' competition' ? What we saw at Ponders End last October was again a gigantic demonstration, the competitions being almost incidental. Through the courtesy of the Eastern Gas Board this their thirteenth Annual Event, had been staged at the new incredibly clean and well-ordered modern Gas Works there. Upon entering the grounds our attention was first of all directed to a large gas holder which was the setting for the Team Test, which itself was a most interesting one. It was assumed that an accident had happened to workmen employed in painting this huge structure. The major part of the team, consisting of four members, arrived in an ambulance five minutes after the occurrence. They found that one of the slings holding the cradle upon which the men had been standing had given way, precipitating it with the men, to the ground. The in'juries sustained by the three workmen were: (a) Internal haemorrhage (gastric ulcer), (b) Fracture of scapula, fractures of 3rd and 4th ribs, haemoptysis and grazes on wrist, forearm and knees (brush burn), (c) Fainting and shock. The remaining two members of the team we were to meet later on taking a test in Diagnosis. Passing the mobile canteen, where firstclass refreshment could be obtained, and which was staffed by the Flying Food Squad of the Women's Voluntary Services, under the supervision of Miss E. F. Dunn, who showed us their well-equipped portable kitchens, sign-posts directed us to the various sec,i::ms of the exhibition. On one corner was a stand where information could be obtained from Mrs. Hoskin respecting the activities of the Royal Society for the Prevention of Accidents, and not far away was another stand where one could meet officers of the Institute of Civil Defence. A short distance further on we watched a series of demonstrations staged by the Civil Defence Corps from Enheld and Cheshunt and from Messrs. W. H. Smith & Sons branch at Lambeth, in which trapped victims were rescued from various positions. In one a girl had been trapped under a heavy pipe, sustaining a fractured tibia. 1 he man who handled the crowbar was, indeed, an expert. In another case a man had to be extricated from beneath a gigantic iron girder. 1 his was a much more difhcult task, in which jacks had to be brought into use, care being taken that the girder was lifted evenly. This viclim had sustained a fracture of the spine in the lumbar region, and only trained first-aiders can fully appreciate the problem involved here, as the body had to be kept absolutely rigid. Another victim, released from a huge pile of bricks and rubble, was found to be asphyxiated, but his position made the orthod.Ox methods of artificial respiration dithcult. In each case the victim had to be extricated without increasing his injuries-a task requmng that special training which the members

were recelYlng. The rescued 'patients' were then treated by a Mobile Unit of the National Hospital Service Reserve. Diagnosis Entering another building we found in progress the competitions for the remaining two members of the first teams we encountered. They were being examined in Diagnosis. Each member was expected to diagnose correctly tIle following conditions and state how each should be disposed of: (a) Fractured tibia and fibula, (b) fractured spine, (c) asphyxia, (d) abrasions on hands and face, (e) compound fracture of patella, (f) laceration of left leg, (g) burns on chest and hand, (h) abrasions on arm, (i) scalp wound, (j) hysteria. A Ghastly Sight Leaving this building and turning a corner we came suddenly upon a most ghastly sight. Here, lying in a row, were a numcer of 'casualties' which had been excellently 'faked' by members of the Visual Aid team from the Depot and Training Establishment, R.A.M.C, Crookham, supervized by Capt. W. Laskie, R.A.M.C They represented (a) Sucking wound of chest, (b) amputated shoulder, (c) abdominal wound, (d) buttock and gunshot wounds, (e) first, second and third degree burns, (f) flash burns, (g) burnt body, (h) amputated ankle, (i) fractured tibia, (j) lacerated and incised wounds and (k) fractured femur. At a special meeting place members of the Study Circles were welcomed by instructors who gave demonstrations of new make-up techniques, and were prepared to answer questions on the forming and running of Circles and. their up-grading to Branch status. Demonstrations were given every hour of • patients' for first aid and nursing training outside the normal scope of competition work, and these included fractured left femur, fractured base with concussion, Co lies' fracture, dizziness over heart, persistent hiccough, dislocated elbow, perforated gastric ulcer, lacerated right wrist with cut flexor, superficial burns of right hand and forearm, petit mal, fractured pelvis, post epilepsy or fourth stage of major epilepsy, 'winding' (blow in solar plexus), sprained muscles of back, lacerated scalp and blisters on both feet. \\- hi 1st the judges were assessing their marks for the various competitions a demonstration was staged by a Mobile First Aid Unit of the National Hospital Service Reserve, showing the establishment of a temporary emergency hospital, all the material and equipment being carried in a lorry. This was followed by a parade of the 'casualties' which had had to be diagnosed by Nos. 5 and 6 of each team, whilst Dr. Binning gave a most instructive running commentary on each. At the presentation ceremony the chair was taken by the President, H. L. Glyn H.ughes, Esq., CB.E., D.S.O., M.C, M.R.C.S., L.R.CP., Q.H.P., who was accompanied by Mrs. Glyn Hughes, and was supported by Mr. lain Macleod, the

Minister of Health and Mrs. Macleod, Sir John Stephenson, Chairman of the Eastern Gas Board, Maj.-General L. A. Hawes, C.B.E., D.S.O., M.C, M.A., Controller (Home Department), B.R.CS., Air Commodore H. A. Hewat, CB.E., M.B., Ch.B., D.T.M. & H., Medical Adviser, B.R.CS., Major A. C. White Knox, O.B.E., M.C, M.B., Ch.B., Principal Medical Officer, S.l.A.A. and others. The chairman opened by stating that he had a very pleasant duty to perform, and this was to thank Sir John Stephenson and the Eastern Gas Board for their generosity in inviting the Union to stage this, their thirteenth Annual Competition at this magnificent Works. It was very gratifying to note the interest taken by those in high places. He also wished to thank, on behalf of the Casualties Union, the Minister of Health, Mr. lain Macleod, and Mrs. Macleod, for their presence there that day. The results of the competitions were then announced: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.

FIRST AID Staffordshire County Police (winning the' Tulk ' First Aid Tropby). B.R.CS., Worcester. Southend Constabulary. Stoke-on-Trent City Police. S.J.A.B., No. 75, Southend. LCI. Alkali Division, Northwich. N.CB., Desford Colliery. B.R.CS., Corbridge. S.J.A.B., King's Lynn Railway. SJ.A.B., Reading Police. East Riding County Police. Eastern Gas Board, S1. Albans. See board, Worthing. B.R.CS., Norfolk/57. B.R.CS., Dumbarton. N.CB., Dawdon Colliery' A.' S.l.A.B., Redruth. S.J.A.B. of Ireland, Dublin. S.J.A.B. No. 17, Wimbledon and Merton. S.J .A.B. No. 117, Southgate. SJ.A.B., Maidenhead Nursing. SJ.A.B., CN. 25, Southgate' B '. SJ.A.B., Tilmanstone Colliery. B.R.CS., Surrey, Farnham.

DIAGNOSIS N.CB. Desford Colliery (winning the , Diagnosis' Trophy). 2. S.J.A.B., No. 17, Wimbledon and Merton. 3. East Riding County Police. 4. Stoke-on-l rent City Police. 5. B.R.CS., Corbridge (5) } I.CI. Alkali Division (6) tied SJ .A.B., Reading Police (7) 8. S.J.A.B., Redruth. 9. SJ.A.B., King's Lynn Rail- ) ~ t" d way (9) ... Staffordshire County Police I Ie (10) I 11. N.CB., Dawdon Colliery' A'. 12. S.J.A.B., of Ireland, Dublin. 13. B.R.CS., Surrey, Farnbam. 14. S.J.A.B., Tilmanstone. 15. Eastern Gas Board, S1. Albans. 16. Southend Constabulary. 17. B.R.CS., Norfolk/57. 1.

FIRST AID & NURSING, JANUARY/FEBRUARY ]956 ] 8. ] 9. 20. 21. 22. 23. 24 .

S.J.A.B., Maidenhead Nursing. S.J.A.B., CN. South/!ate ' B '. S.J.A.B. No. 75, Southend. S.J.A.B., No. 117, Southgate. B.R.CS., Dumharton. Seeboard, Worthing. BR CS W /1 . . . . , arcester. BUXTON TROPHY

Staffordshire County Police (winning the Buxton Trophy for highest aggregate of points in Diagnosis and First Aid). 2. Stoke-on-Trent City Police. 3. N.CB., Desford Colliery. 4. Southend Constabulary. S. I.CI. Alkali Division, Northwich. 6. B.R.CS., Worcester/ I. 7. East Riding County Police. 8. B.R.CS., Corbridge. 9. S.J.A.B. No. 75, Southend. ]0. S.J.A.B. King's Lynn Railway. ] ]. S.J.A.B. Reading Police ]2. S.J.A.B., No. 17, Wimbledon and Merton. 13. Eastern Gas Board, St. Albans. 14. N.CB., Dawdon Colliery' A '. 15. B.R.CS., Norfolk /57. 16. S.J.A.B., Redruth. 17. Seeboard, Worthing. 18. B.R.CS., Dumbarton. 19. S.l.A.B., of Ireland, Dublin. 20. S.J.A.B., Maidenhead Nursing. 21. S.J.A.B., CN. Southgate' B '. 22. S.J.A.B., Tilmanstone Colliery. 23 . S.J.A.B., No. 117, Southgate. 24. B.R.CS., Surrey, Farnham. B.R.CS., Dumbarton, won the Civil Defence Trophy, presented by the Institute of Civil Defence, to be awarded to the team 1.

that each team will feel spurren on as a result of I istening to him. He wisherl. also to add his thanks to Sir John Stel")h~nso~ for his ki,:,dness and generosity. The large arn;y ?f Judges w~o had so kindly given theIr tIme and skIll m~rited their sincere gratitude, awl eS'"lecially Drs. L. Wills and Binning. The judges were:

subjects by well-known writers. One cannot help noting the tendency to adopt the practice now becoming popular in the United States of illustrating these First Aid and Nursing articles with simple pen-andink sketches, often containing an element of humour, which undoubtedly have the effect of impressing the main points upon the memory. This is much to be commended. An outstanding feature of the booklet is the article from the pen of Sir Gerald Wollaston, K.CB., K.CY.O., K . S1. J. who relates in a most interesting manner the story of the Order of S1. lohn, and who could be more qualified to write such an article than the Garter Principal King of Arms from 1930 to [944, since Norroy and Ulster King Df Arms and a member of the Council of St. John for Kent? Of the technical articles, Mr. Dennis Clark, M.B.E., M.B., B.S., F.R.CS. has written some very instructive notes on Artificial Respiration, a subject which has been receiving more and more attention during the past two or three years as further research and experiment reveal the defects of methods used in the past.

the old horse-drawn ambulances designed by Sir John Furley. Before concluding, may T be forgiven for indulging in some reminiscences, for it was in the Chatham District that I first became associated with the movement, and the Directory and one or two of the photographs have recalled many pleasant memories? I would like to offer my congratulations to those whose names I recognize as holding responsible positions in the Kent Brigade to-day. Corps Secretary Yeman (Chatham) was Secretary and Divisional OffiCt'r (then called Ambulance Officer) of the Chatham Town Division when I left Kent to come to Sussel( 30 years ago, and Corps Supt. W. Adams was a corporal, whilst Div. Supt. Vrolyk (now on Reserve) Div. Officers Graham and Allen were serving in the ranks. The Di visi onal Surgeon at that time was H. 1. Hoby, O. St. J., M.R.CS., L.R.CP. (who was responsible for failing to correct the galley, page 53, in which he is described as • Dr. H. J. Holey' ?), and it is pleasing to learn that he has since roped in his wife, Mrs. 1. M. Hoby, S.R.N., S.C.M., who is Assistant Staff Nursing Officer. Congratulations, also, to Corps Supt. F. A. Lelliott and Cadet Supt. Miss C F. Baker (a founder member of the Chatham Nursing Division) whose names appear in the honours list for 1954. M r. Vrolyk is also a Serving Brother. I trust that I may again meet some of them at the' Dewar' this year. Major Clive Bossom is certainly to be congratulated upon the production of an outstanding booklet, and I hope that his example will be followed in other counties.

-----------------------------

Tile O.-de.- in Kent

LYING before me on my desk has been far some little time past one of the most readable year books it has ever been my privilege to read. Produced in a good quality art paper and robed in an imposing black and white jacket, the County Year Book of the Council of the Order of S1. John for Kent for the year 1954, was sent to me by its enthusiastic Editor, Major Clive Bossom, O. St. J., who is also Chairman of the Council, but who hastens to acknowledge the valuable assistance he has received from Miss M. Stables in its production. It has been a matter for deep regret that the phenomenal increase in the number of major competitions last year has compelled me to defer reviewing this storehouse of information until the present. Following a complete Directory for the County of the Council of the Order, the Association and the Brigade, most stimuLating messages appear from the President, The Rt. Hon. Lord Cornwallis, K.B.E., M.C, K. St. J., and the County Commissioner of the Brigade, Major-General A. H. Hornby, CB., CB.E., M.C, C St. J., both of whom have taken an active interest in the work for many years. Year books and annual reports are usually pretty dry stuff, but this one is unique in creating a desire for more. Everyone of its 70 pages is packed with valuable information, presented in a most fascinatiag manner, and profusely illustrated. 1 he Editor has aimed at giving his readers a complete digest of the activities of the various foundations of the Order in Kent, but in addition has been successful in obtaining contri butions on technical

of predominently opposite sex to the winners gaining highest aggregate points. Brilliant Realism of Settings T .. t n nSlDg 0 present the Trophies, Mr. Macleod said that he had seen a good many competitions in his time, but he had never before seen one like this. He had been amazed at the brilliant realism of the settings and the dramatic presentation of the many everyday accidents. The acting of the members had been excellent. It was a tribute to the Casualties Union to have been able to attract support from all parts of the United Kingdom. He was most grateful to the Casualties Union for the great help it was rendering to the cornmunity. It was most appropriate that the Competitions should have been staged in an industrial area like Ponders End. Many of the 'casualties' he had seen that day could have been war casualties some domestic, but all had been represented with equal success. It was worthy of note that accidents in the home outnumber all others taken together. 'Would you know what to do in an emergency?' he asked. 'Then you should find out as soon as possible,' he replied to his own auestion. He felt that women in particular ' should have a general knowledge of First Aid. Injury can come so unexpectedly in the home. He coneluded by exhorting them to join one or other of the voluntary organizations which would teach them what to do in an emergency. After Mr. Macleod had presented the Trophies Mr. E. Claxton, President of the Council, thanked Mr. Macleod for his inspiring talk, and also Mrs. Macleod for coming there that day, and he felt certain

Mr. T. Veevers-Thompson, S.B. St. J., Curator of the Library of the Order at S1. John's Gate, contributes a pen-picture of Sir John Furley, relating many little-known facts about this great pioneer. It is interesting to learn that on 1st April, 1878, he initiated the Ashford (Kent) Corps and six weeks afterwards [olmed the Sevenoaks (Kent) Corps, and this only two years after the establishment of the St. John Ambulance Association itself. On the opposite page appear~ a photograph of the Ashford Corps of half-a-century ago, with one of

First Aid Dr. L. Wills, of Wem~ley; Dr. F. H. Taylor, of Streatham; Dr. R . S. Barr Brown, of Bethnal Green; Dr. D. Eval1s, of Alderm'lston; Dr. H. E. O'1oni of Reigate' Dr. 1. Scriven , of Farnham; o'r. A. Owen; of Horsham; Dr. D. Pride, of Aldermaston' Mr. G. Bug1e"1. of Brentford: Mr. W. A: ~he~n~ of Islington; Mr.. C F. Blake, of Bnxton; Mr. J. W. LImb of Lewes' Mr. S. W. Hardel1, of Londo~ ; Mr. S. V: Thomoson, of Potters Bar; Mr. H. Marriott of Enfield ; Mr. R . Mcnamara of Brighton ' Mr. E. L. K. Dunn, of South' Harrow. ' Dia~nosis

Dr. 1. S. Binning, of Harpenden; Dr. J. D. McFadyen, of Stirling; Dr. R. G. Brins Young, of Lewes; Miss M. Lock, of Southend; tyrr. A. S. Matheson, of Hungerford; MISS Y. M. Brand of Kensington; Mr. G . Waller, of Wimbledon' M~ss Austin, of Barnes; Mr. E. J. West, of MItcham. It would be impossible, Mr. Claxton went on, to mention everyone by name who deserved their thanks, but a few who might be mentioned were the Royal Society for the Prevention of Accidents, the R.A.M.C, the N.H.S.R., the Institute of Civil Defence and the Ci Jil Defence Corps, the Boy Scouts and the W.V.S. who fed us.

- F.c'R.

FIRST AID & NURSING, JANUARY/FEBRUARY 1956

FIRST AID & NURSI G, JANUARY/FEBRUARY 1956

Collapse Therapy Used in Pulmonary Tuberculosis By W. James Wright, S.R.N., B.T.A. IN my article on Pulmonary Tuberculosis in a previous issue (March /April, 1955) I mentioned that the affected lung must be rested, by surgical means if necessary. I now propose to describe briefly the surgical methods used to produce this rest. It must be realized that not all cases of pulmonary tuberculosis require surgical treatment. Artificial Pneumothorax The lungs are covered with two layers of membrane, the pleura, and between these two layers there is a potential space, the pleural space. In respiration these two layers glide smoothly over one another. The inner layer of pleura is attached to the outer surface of the lung, while the outer layer of pleura is attached to the chest wall. In artificial pneumothorax the aim is to induce a measured amount of filtered air into the pleural space by means of a special hollow needle which is connected by a length of rubber tubing to a special apparatus. The patient lies on the unaffected side and a firm pillow is placed underneath him. The arm is raised above the head. A suitable area is selected and the surrounding skin is cleaned with spirit. The area chosen is anaesthetized by injecting a local anaesthetic. A few minutes are given to allow the anaesthetic to take effect then the sterile needle is inserted between two ribs into the pleural space and the filtered air is introduced. This causes the lung to collapse thereby allowing it to rest. A manometer on the apparatus indicates the pressure in the pleural space and guides the doctor as to how much air is required: periodical ' refills' of air must be given as the air becomes absorbed. This form of treatment can be continued on the average from four to five years. Division of Adhesions Occasionally when an artificial pneumothorax is in progress, bands of fibrous tissue, adhesions, prevent the lung collapsing completely. Adhesions are caused by patches of inflammation. If possible these adhesions must be cut or divided, but first the surgeon must examine the inside of the chest to see if this is possible. For this the operation known as Thoracoscopy is performed. Before this operation is commenced a refill of air must be given to ensure enough free space to admit a small telescope known as a thoracoscope. The axilla, back and chest having been previously shaved, tbe skin is now cleaned with spirit. The patient lies on his unaffected side with his arm above his head. By means of chest X-rays, etc., the position of the adhesions will have been previously located, so that an intercostal space as near the adhesions as possible is chosen. The skin is again cleaned with spirit and local anaesthetic is injected under the skin and into the deeper tissues. An

incision about half an inch long is made through the skin and an artificial pneumothorax needle with a blunt stillette is introduced to assess the depth of the pleural space. The needle is removed and a trocar and cannula is pushed through into the pleural space. The trocar which has a sharp point is removed leaving the cannula, which is a special metal tube, in the chest wall. The thoracoscope which has a tiny electric bulb on its end is introduced The operating through the cannula. theatre is now darkened and with the aid of the light on the thoracoscope the surgeon examines the inside of the chest. If it is possible to divide the adhesions a small cautery is used which seals off the blood vessels as they are cut. In some cases the cautery can be passed through the same cannula as the thoracoscope but in other cases it has to be passed through another cannula at another spot. Phrenic Paralysis Phrenic paralysis is a minor operation performed to paralyse one half of the diaphragm. The axilla and chest on the affected side are shaved a considerable time before the patient goes to the operating theatre. A preliminary sedative is given one hour before the operation is due to commence. In the operating theatre the patient is placed on his back with a firm pad between his shoulder blades to throw his shoulders back. The head is (urned to the unaffected side. The skin at the base of the neck on the affected side is cleaned with spirit and local anaesthetic is injected under the skin and into the deeper tissues. When the anaestbetic has taken effect a small incision is made and the phrenic nerve is found and exposed. All large blood vessels are tied off as they are cut. The phrenic nerve, now exposed, is injected with local anaesthetic, and is then either crushed with forceps or removed entirely. If it is crushed it regenerates in about six months, but if it is removed it causes a permanent paralysis. In either case the affected half of the diaphragm rises up into the chest cavity and pushes up the lung thus restricting its expansion. Severe respiratory embarrassment would be caused if both halves of the diaphragm were paralysed at the same time. Pneumoperitoneum Pneumoperitoneum is sometimes performed on its own but is usually done following phrenic paralysis to help raise the diaphragm further Air is introduced into the peritoneal cavity beneath the diaphragm. The left side is chosen normally to prevent damaging the liver which is on the right side. The apparatus used is the same as for artificial pneumothorax except that a blunt needle is used. The patient lies on his back and may be asked to raise his head when the needle is inserted, to relax the

abdominal muscles. The site usually chosen is the left costal margin. The skin is cleaned with spirit and local anaesthetic is injected under the skin. When the anaesthetic has taken effect the sterile needle is pushed through the skin into the peritoneal cavity, and the air is introduced thus forcing the diaphragm up causing relaxation of the lung. It is most beneficial where the lower part of the lung is affected. The manometer readings guide the doctor as to the amount of air required. Refills of air must be given periodically as the air becomes absorbed. The length of time that pneumoperitoneum can be continued varies. Thoracoplasty Thoracoplasty is a major operation so I have had to describe it very briefly. The operation is usually done in two and sometimes three stages with two or three weeks between each stage. The hair is shaved from the chest and back, from the neck to below the waist and the skin is cleaned with spirit and covered with sterile towels. This is done on the ward well before the time of operation. A sedative is given the night before the operation to allay anxiety and to help the patient to get a good nights' sleep. An injection of some morphine preparation is given one hour before the operation is due to commence. The patient is taken to the operating theatre and placed on the operating table on his unaffected side and is propped in that position. A nurse holds the upper arm on the affected side and wben asked by the surgeon pulls gently to pull the shoulder blade forward. Local anaesthetic is injected under the skin and into the deeper tissues along the site where the incision is to be made. The skin is again well cleaned with spirit and when the anaesthetic has taken effect an incision is made from the level of the shoulder around the scapula to curve towards the ribs on the affected side. the ribs are exposed and the membrane which covers them (periosteum) is stripped back. From this membrane new ribs will eventually grow. The first two ribs (counting from the top downwards) are completely removed and probably a portion of the third is removed from the end attached to the spine. This causes collapse of the lung in this area. The amount of rib removed depends upon the amount of collapse required. The muscles are then stitched, the wound is closed and is also stitched. When the second or third stages of the operation are performed the original incision is reopened and the required amount of ribs are removed. Usually a blood transfusion is given during the operation and for a while afterwards. . If the patient does his exercises properly between each stage of the operation and after the final one for as long as required there need be no fear of deformity.

~. F. ~. Jones, peputy Chai~man, the Gas Council, congratulates J. A. Clague, captain of the )\inning team in the Gas Industry's National FITst Aid Competiho,n. Standing between them is P. D. WeIman, Chairman of the North Western Gas Board. The team are from the Liverpool G.roup ?f the Boa~~ s area. The .Nort~ Western Gas Board Team from the Liverpool Group of this Board who are tbe winners of this year's FITst Aid CompetitIon, are seen ill actIOn during their team test. Members of the team are: J. A. Clague (Captain) R. Woods A G N. Jones and A. E. Young (Reserve). ' , . reen,

GAS INDUSTRY FIRST AID FINALS Report of the Competitions held at County Hall, London ONCE again Mr. Therm reminds us that his benefits to the community are not confined to providing iUumination and heat, but that he can produce individuals capable of dealing with accidents and sudden illness in a most efficient manner. In order to prove this clainl a dozen teams drawn from Gas Boards throughout the British Isles competed at the Conway Hall, London, for the coveted Trophy and Plaques presented by the St. John Ambulance Association, tackling the most difficult tests in a most businesslike manner. In the team test the competitors are passing a cafe when they are asked to treat a man who has been accidentally knocked down by a waitress carrying a large tray of crockery. He is found to be suffering from a scald on his right hand, a simple fracture of left clavicle, wound of left palm and a sprained knee joint. He also has nerve shock. The waitress is not hurt, but dazed. This was set and judged by Dr. J. e. Graham, of London. In the individual tests Nos. 1 and 2 are asked to treat a housewife suffering from a fractured right fibula, a lacerated wound of right forearm and shock. Nos. 3 and 4 are called to a man who has been rescued from a room filled with fumes from a coke fire. He also has a cut on his head and a strained calf muscle. These tests were set and judged by Dr. Michael Cohen, of London. At the presentation ceremony the chair was taken by Lt.-General Sir Otto Lund, K.e.B., D .S.O., Commissjoner-in-Chief of the St. John Ambulance Brigade, who was supported by Sir Ralph Hone, Sir Henry Pownall, K.e.B., K.B.E., D .S.O., M.e., Chancellor of the Order of St. John, Henry

F. H. Jones, Esq., M.B.E., Deputy Chairman of the Gas Council, and Mrs. Jones, and the judges. Sir Otto apologized for the absence of Mr. Horace F. Parshall, T.D., M.A. (Oxon.), Director-General of the Association, and Major A. e. White Knox, O.B.E., M.e. , M.B., Ch.B., their Principal Medical Officer. It was very gratifying, he said, to note the growth of the Association's work. In 1954 no less than 8,323 instruction classes had been held against 7,878 in 1953, and 85,115 new certificates had been gained by students compared with 80,796 the previous year. It was from these classes that volunteers for the Brigade were recruited. After thanking the Associated British Picture Corporation Ltd., for again supplying and erecting the scenery, the stewards, ' patients,' the competition secretary, Mr. George Craft, and especially the judges, he asked Mr. Craft to announce the results: 1.

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

12.

North Western Gas Board (winning the Championship Trophy) North Thames Gas Board Eastern Gas Board South Western Gas Board East Midlands Gas Board Southern Gas Board ... Scottish Gas Board South Eastern Gas Board West Midlands Gas Board North Eastern Gas Board Wales Gas Board Northern Gas Board

284

281 26H 268264t

251 245 243 238 229~

229169t

Too much talk In response to an invitation from the chair Dr. Graham commented upon the

team test. He commenced by saying that the general standard of work had been good, and it had appeared to improve as the day went on. In the first place, the leader should lead. The otbers are there to be led, but each should be competent to work independently without detailed instruction. On one occasion three people were talking at once. A doctor depends much upon what the patient tells him, and the leader should bear this in mind when examining a patient. He should listen to the patient in a quiet, confidential manner, and should not try to do too much himself. He concluded by saying that he had enjoyed every minute of the day. Too many questions asked Dr. Cohen followed, and agreed ",Jth Dr. Grabam that the standard had been good. Too many questions, however, are asked, and in many cases they are asked so quickly that the judge has no time to answer. He reminded them that words of comfort and encouragement do much to relieve the anxiety of the patient, and they must not forget to treat hock. Ask the patient, if conscious, where the pain is. His answer will often provide valuable clues. There is, he said, not much point in taking the pulse of an asphyxiated patient. Like Dr. Graham, he had thoroughly enjoyed his experience that day. No Decline in Voluntary Work The chairman then asked Mr. Jones to present the awards and in doing so he said that if there were people who com pia ined that there was a decline in voluntary work, then they should see what is being done by the S1. John Ambulance Association and its members.

FIRST AID & NURSING, JANUARY/FEBRUARY 1956

General Post Otliee Finals next you purchase a 2td. stamp WHEN at the Post Office be sure you pay the greatest respect to the lady or gent.leman who serves you, for you may be lD the presence of a member of one of the crack G.P.O. first aid teams, or even of t~e champion team itself. The identity of this team was decided at the Porchester Halls, Bayswater, when the G.P.O. National First Aid Competitions were held under the auspices of the St. John Ambulance Association, an~ consisted of team an,d individual practIcal tests for both men s and women 's teams. In the men 's team test, which was set and judged by K enneth Duncan, Esq., B.Sc:, M.B., Ch.B., D.I.H., of Bath, the team IS called from practice to attend a m~n who has been repairing an old wall, whicb has collapsed on him. He is found to. be suffering from a fracture of the ng?t humerus (mid-shaft), a fractured pelVIS, haemorrhage from a wound of the left hand and shock. The women's test team is practising at their headquarters when they are called by a neighbour to attend a woman who has fallen from a chair, striking her head against the fen der. Her husband, ~itting on a chair, is restless, vague an~ will not give coherent answers to questIOns . Examination reveals that the woman has a bruise over the left temple with concussion and a closed fracture of the left thigh. Three minutes after commencement of the test the husband collapses on the floor with diabet ic coma. The test was set and judged by Sheila M . M. Niall, L.M.S.S.A., D .C. H., of Pinner.

Dual Practical Tests Nos. 1 and 3 men have been called by the police to deal with a man who has been assaulted, but there has been an unfortunate delay of half-an-hour. He is found to have a laceration of the left temple, a depressed fracture of the skull and compression. Nos. 2 and 4 men witness the fall of a slater from a roof, a distance of some 15 feet. Exami nation reveals a fracture of base of skull with concussion. 1 hese were set and judged by J. S. Binning, Esq ., M.B., Ch.B., of Harpenden . Nos. I and 3 women are called to attend a man who has fallen from a ladder. His injuries include a strain of the right shoulder muscles, a sprained left ankle joint, abrasion of left wrist and shock. Nos. 2 and 4 women, answering a call for help, find a woman who bas slipped on a step, and is suffering from a Colles' fracture (right), a fractured right patella and shock. Tbese were set and judged by A. Conn, Esq., L.R.c.P .. L.R.C.S., L.R.F.P.S., of Ewell. At tbe presentation ceremony Mr. Horace F. Parshall , TD., M .A . (Oxon.), occupied the chair, and was supported by Mrs. Charles Hill and Mr. R. J. P. Harvey, C.B., Deputy Director-General of the Post Office. The chairman expressed the regret of all at the absence of the PostmasterGeneral, but welcomed his lady who bad graciously consented to deputL.e for him in presenting the Trophies and Plaques presented by the St. John Ambulance Association. The stewards and' patients' could

never be thanked enough, and he particularly wished to thank the judges for giving their time and skill to forward this great movement. Lack of Team Spirit Dr. Niall, who had judged the women's team test was the first judge to comment upon the'test she had seen. She criticized the lack of team spirit, stating that they had worked rather as individuals than as a body. There was frequently a tendency to confuse diabetic coma with insulin overdose. Beyond these two comments she could find little fault, and the work, altogether, had been good. Dr. Duncan spoke for Dr. Binning and himself. He said that they were agreed that attention to detail had not been quite up to standard. However, the roughnesses in team working which they had detected would, they felt sure, soon be ironed out. He would remind the competitors that, if the patient is conscious, he could be asked more questions which would help their di ;;.~ nosis, and, finally, they must try to appreciate fully the whole position. On the whole, the work had been good. The results were then announced by Mr. George Craft, the con.petition secretary: RESULTS Men. Maximum marks obtainable, 400. 1. Weymouth H.P.O. (South Western) ... 281 (winning the S.JA.A. Challenge Trophy) 2. North Area TM.O . (London Telecommunications) 279 3. Edinburgh Factory (Factories) 271 4. Acton S.B.D. (Savings Bank) 262 5. Inland Section (London Postal) 257 6. A. 7 P.R.D. (Headquarters Building) . 256 7. Belfast TM .O. (Northern Ireland) 241t 8. Perth P.O.A.C. (Scotland) 235 9. Reigate-Redhill H.P.O. (Home Counties) 234t 10. London Test Se-ction ) (Engineering) Jl tied 231 11. Birmingham P. O.A. C. (Midland) 12. Liverpool H.P.O. (North Western) ... 224 13. Cardiff P.O.A.C. (Wales and Border Counties) 219 14. Edinburgh Depot (Supplies) ... 209 15. E.TE. Headquarters (External Telecommunications Executive) .. . 198t 16. Bradford TM.O. (North Eastern) . .. 189 Winners of the Runners-up Trophy: London Telecommunications. Winners of the Best Pairs Tropby: Nos. 2 & 4, Belfast } t' d Nos. 1 & 3, Weymouth Je Women. Maximum marks obtainable, 400 1. North Area TM.O. (London Telecommunications) 359! (winning the S.J.A.A. Challenge Trophy) 2. Morecombe S.C.D. (Savings Bank)... 346~ (winning tbe Runners-li P Trophy)

FIRST AID & NURSING, JANUARY/FEBRUARY 1956

Birmingham P.O.A.C. (Midland) .. . 333 t 4. Bristol T.M.O. (South Western) 323 5. Headquarters Building (Accountant General's) 317 6. York H.P.O. (Nort~ Eastern) ... 304 7. Manchester T.M.O. (North Western) 294 8. Birmingham Factory (Factories) 292 9. Engineer-in-Chief's Office (City) (Engineering) 280 10. Belfast TM.O. (Northern Ire... '" 273t land) 11. Dundee P.O.A.C. (Scotland) ... 260 12. Cardiff P.O.A.C. (Wales and Border Counties) 259 246 13. London Depot (Supplies) 14. E.T.E. Headquarters (External Telecommunications Executive) 240 ~ 15. Ipswich H.P.O. (Home Counties) ... 226! Best Pairs Troph y won by Nos. 2 and 4, North Area T.M .O. Before presenting the Trophies and Plaques, Mrs. Hill apologized for the absence of her husband, f9r he had always taken a very keen interest in the ambulance movement. She congratulated the teams upon the work which they had exhibited .

\,\'ound ; only the repair squad can do that. The

Obituary

drawback of the older antiseptics, such as acri-

The death of Corps Officer (Retd.) Richard Moat, O. St. J ., Vice-President and Treasurer of Folkestone Corps at the end of last year has meant that the Corps has lost a most valued worker and loyal supporter. Mr. Moat joined the Folkestone Ambulance Division in 1909, he became an N.C.O. , and later Ambulance Officer and Treasurer. In 1929 he was admitted into the Order of S1. John as a Se(ving Brother, and then in 1935 on the formation of the Folkestone Corps he became Corps Officer a nd Treasurer, a position he held until his death . In J 949, he was promoted an Officer of the Order of S1. John . He retired from the active list of the Brigade on December 3 J st 1952, and then in January, 1954, together with his lifelong friend and colleague Corps Officer (Reld.) Len Easton, O. St. J. , he was made a Vice-President. During the first World War he served in the R.A.M .C. and in the last war he played a big part in training the A.R.P. personnel. The funeral took place at Hawkinge Cemetery, and was preceded by a Service in the Folkestone Baptist Church. The Brigade was represented by: Area Commissioner B. T. Beaumont, C. st. J. (who also represented the County Commissioner, Maj.-Gen. Hornby) Area Supt. (N), Mrs . A. Jay, S.S. St. J ., Area Officer E. A. Herbert, S.B. S1. J ., and Officers and Members, and Divisional Presidents of the Folkestone Corps, and Officers and Members of Hythe Ambulance and Nursing Divisions. The members also attended a Memorial Service at the FoLkestone Baptist Church on the following Sunday Evening.

AaYine, tincture of iodine, propamidine, etc., is

The Repair

Squad When you receive a wound or a burn, your body mobilizes its repair sguad to make good the damage. Infection by bacteria hinders the repair squad in its work and may even overwhelm it, so that th e wound heals ~lowly or not at all.

infection mLlst be pre\'ented or suppressed, and this some of the olde r antiseptics do quite effectively. But no antisep tic, however efficient, will heal a

that they interfere with the repair squad's activities -

and thus themselves slow down the process of

healing. , Furacin " hO\yeyer, is an entirely new type of germi cide, which destroys bacteria and pre\'ents infection outstandingly well, and yet leaves the repair squad unharmed to get on with healing the wound. For this reason, 'furacin' is becoming more and more wide1;' llsed in ho pitals and first-aid rooms in this country and America. Made up as an ointment, it is eas), to handle, and stable, and is a\ailable in a range of pack sizes to suit all user s.

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Glass with Care In the September/October, 1955, issue of this journal we published an article with the above title, and included was a photograph of a glass factory's first aid room. The organization and application of first aid was described at this factory , which was that of Rockware Glass Ltd. , Greenford, Middlesex.

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FIRST AID & NURSING, JANUARY/FEBRUARY 1956 10

Sister Hutchings Cup and Gravestock Trophy Finals

was held again this year at the Chiswick Works when the entry was once more a large o'ne. The competition consisted of a team test, set and judged by Dr. C. J: P. Seccombe, of Southall, and o~al questIOns set and judged by Area Supermtendent H. Dunford, S.J.A.B. The team test was an appropriate one for London Transport. The team are preparing a first-aid post when they hear a bang on the other side of t~e wall. Investigation reveals a 'bus ",:,hlCh has backed and is pinning a man agalOst the wall. He is found to be suffering from shock (nervous and haemorrhagic), internal haemorrhage from spleen and fractures of both. legs. Three interesting innovations were mtroduced for the purpose of testing the reactions of the competitors: (a) A low wall which had to be scaled before the patient could be reached, (b) The stretcher proved to be defective and (c) A doctor pronounced the patient dead before he could be loaded into the ambulance. Dr. L. G. Norman, O. st. J., Chief Medical Officer of London Transport, presided at the presentation ceremony, and expressed his pleasure in welcoming the visitors, including Mr. George Craft, the well-known S.J.A.A. Competition Secretary, and Mr. F. C. Re~ve, of First Aid and Nursing. He explamed that he had been asked to deputize for Mr. Alex J. Webb, C. St. J., who had sent apologies for his unavoidable absence. Other London Transport officials present included Messrs. T. T. Shephard, J. H. Williams, G. Yorke, A. E. Flack, H. F. C. Adcock, H. Walker and L. R. Cotton. It was a tribute to the organization, said Dr. Norman, to note the large number of entries for the event, in which the officials took so deep an interest. Toxic Shock In response to the invitation of the Chairman, Dr. Seccombe commented upon the team test. He said that, although toxic shock was more rare than the other types, it must be recognized and treated according to the text-book. In the case of internal haemorrhage it was not enough to diagnose it. The patient should be repeatedly examined in order to note his progress. In diagnosis there was a tendency to jump to conclusions before the examination had been completed. Not all had exhibited the anxiety they should have done in respect of the unsafe stretcher. He complimented the ' patients' upon the manner in which they had played their part, and concluded by thanking all those who had helped him. He was followed by Mr. Dunford who emphasized the point that, 'You' must know your book.' The answers were good, but he felt sure that many of those who failed to answer correctly some of the questions really knew the answers, but were, possibly nervous. He believed that tJ;tey would do the right thing at the right tune. The results were then announced: Team Test: 1. Chiswick 144 (winning the Sister Hutching~ Cup)

3. 4.

5. 6. 7. 8. 9. 10. 11. 12. 13.

Romford' A ' 130 (winning the Gravestock Trophy) Baker Street (Women) ... 115 (winning Third Prize) 113 New Cross ' A ' (winning Fourth Prize) 110 AJdenham' B ' (winning Fifth Prize) 105 Reigate (Women) 100 North Street' B ' 92 New Cross' B ' ... l tied 86 Guildford ... J Sutton' A' 84 Amersham 72 Sutton (Women) 68 Dunton Green' A'

Oral Test: 1. Chiswick 2. Dunton Green' A' 3. Upton Park' C' 4. Amersham

Clapham :::} tied 18 6. Chelsham 7. Watford (Women) ... 16 Sister F. M. Hutchings presented the Sister Hutchings Cup to the winning team, Mr. J. A. Gravestock, M.B.E., presented the Gravestock Trophy to the second team and the prizes to the next three teams were presented by Mr. C. F. Harrison, M.C., Divisional Superintendent, Central Road Services and Chairman of the No.3 (North East) District of the Centre. Mr. J. R. Garwood thanked the judges for their great help, and remarked upon the very large entry this year. A vote of thanks to the Chairman and those who had presented the trophies and prizes, proposed by Mr. 1. W. Standring, was carried with acclamation. Mr. S. W. Harden, the Centre Secretary, thanked the teams for their continued support, and the officers and officials for their assistance in the work of the Ambulance Centre, as well as the secretaries and stewards who had given so much help in making the competition the success it had proved. 5.

London Transport A.mbulance Centre is one of th~ J:i.ghlights T HISof competition London ambulance actIVItIes, and

FIRST AID & NURSING, JANUARY/FEBRUARY 1956

40 34

24 22

Sussex Open Competition THE fourth Annual First Aid Competition

organized by the Sussex Open First Aid Competition Association was held in the Town Hall, Worthing, and the rapid success of the Association may be judged by the fact that no less than 23 teams had entered to compete for the four trophies which it had acquired, besides individual prizes for the members of the first four teams. In the team test, set and judged by H. S. Taylor-Young, Esq., F.R.C.S., of Salisbury, the team has to deal with a waiter in a cafe who has become trapped in the food service lift. After extricating him they find that he is suffering from a fractured spine, a wound of the left arm and a (brush) burn of the right hand. In the individual practical tests Nos. 1 and 3 find a man who has fallen from a ladder into a garden frame. His injuries include a severe cut across the back of the right thigh and concussion due to a blow on the back of the head. This was set and judged by Dr. A. M. Pollock, of Tunbridge Wells. Nos. 2 and 4, upon visiting their newsagent, whom they know well, find him on the floor unconscious, having taken poison (cyanide). There is a small wound on the right wrist. A.R. is indicated as well as treatment of wound. This was set and judged by Dr. S. R. Matthews, of Cra~ley. At the presentation ceremony the chair was occupied by Chief Constable PattersonWilson, O.B.E., of Worthing, who was supported by the Duke of Norfolk, the Mayor and Mayoress of Worthing, Sir H. C. and Lady Sinderson, K.B.E., C.M.G., M.V.O., O. St. J., Councillor Morecroft, Dr. H. Rosenberg (County Surgeon, S.J.A.B.) and Mrs. Puckert. In his opening remarks the Chairman expressed the thanks of all to the Duke of Norfolk for coming there that day to present the trophies. As they all knew, His Grace took a deep interest in the ambulance movement. The Chairman also expressed the appreciation of the Association to the Mayor and Mayoress of

Worthing for their deep and practical interest, and to the Mayor and Corporation of Worthing for the use of their magnificent Town Hall, which had proved an ideal building for the event. They were, also, most grateful to the judges, most of whom had come long distances in order to help them. They must, also, acknowledge the valuable help which had been rendered by the stewards, timekeepers, • patients' and especially the competition Secretary, Inspector E. W. Adamson, of the Worthing Police, in whose capable hands the event had been so successful. For the scenery, which had contributed in no small measure to its success, they were indebted to the manager of the Theatre. The results of the competition were then announced, and were as follows: 294t 1. West Sussex Constabulary (winning the Duke of Norfolk Bowl) 285 2. Brighton Police' B'. ... (winning the Van Dyck Cup) 3. Worthing S.J.A.B. 270 4. British Railways, Brighton ... 266 5. British Railways, 264 Lancing' B ' l tied 6. Hastings Police I 263i 7. East Sussex Police' B ' (winning the Sussex Mayors' Association Cup) 262 8. Brighton Police • A' ... (winning the Puckert Cup) 257t 9. Worthing S.E.E. Board 243t 10. Eastbourne Police 242t 1 J. East Sussex Police' A ' 234 12. Brighton Power Station 216 13. Hastings Town S.l.A.B. 214t 14. EastboLlrne S.J.A.B. .,. 15. Crawley and Three Bridges S.l.A.B. 210~ 16. Arundel B.R.C.S. 209 17. Crowborough B.R.C.S. 205t 18. British Railways, Lancing' C' 193 19. Eastbourne S.E.E. Board 182t 20. Hastings S.E.E. Board 157 The Chairman then invited the judges to comment upon the tests which they had Continued 011 page 14

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From a Seat in the Audience Grand Prior The significance of ' rustory , is not fully appreciated. 'Any shortening of the limb?' Why not measure? In several cases it was a one-man team. Is the use of a bell, or other audible sign from the time-keeper's desk, wise? Experienced teams are alert for si~ns. There is no need to tell the Judge what you would NOT do. Three rubs up and down the limb do not constitute 'promoting circulation.' Don't prompt the patient. Let him tell you in his own words. They crawled in, but stood up afterwards. Had they forgotten that the room was smoke-filled?

FIRST AID & NURSING, JANUARY/FEBRUARY 1956

FIRST AID & NURSING , JANUARY/FEBRUARY 1956

* First-~tider~s Crosslcord No. 21

GARROU-L D'8

Compiled by W. A. Potter

for the

Regztlation U nzjor111 for

OFFICERS

Hutchings and Gravestock What was she talking about all that time instead of bringing the splints? Although he slit the stretcher still further in testing, still did not realize that it was useless. Talk about magic! Cups of tea, blankets and hot water bottles are often conjured from the most unlikely places. What a fuss one ladies' team made in negotiating that low wall. Why all those enquiries before supporting the obviously injured man? General Post Office Would you sit a patient up who is suffering with a fractured pelvis? There was too much shifting of material with no apparent object. That cold tea again! What was the use of a blanket lift when the patient had been sitting up? No' load ambulance.' Surely this should form an essential part of any test.

& (Female only)

MEMBERS

OF THE

ST. JOHN

Casualties Union Why telephone for the ambulance when it is standing behind you? .., We were impressed with the qUIet dlgmty of one team leader-no fuss. When will competitors learn the correct method of making a cold compress? In many cases patients were e~po.sed too long. A cold wind was spn0gmg up which should have been taken mto consideration. Where did No.4 disappear to? He was not seen after the first two minutes. 'Keep quite still.' The patient was unconscious! Did it occur to any team to take the cradle as it was, with the patient made comfortable in it? Sussex Open Don't guess the position of the back pad (for spine). It must be exact. 'CLEAR instructions to bystanders ' vide text-book. You cannot get at the femoral artery without removing clothing. 'Pieces of wood' (for fracture boards) not sufficiently descriptive for a layman. 'Thank you, you chaps!' Kicking broken glass from one place to another is not' removing.' All hands should have assisted in releasing the patient. Could swelling (spine) be felt through clothing? Two sips do not constitute 'plenty of fluid.'

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FIRST AID & NURSING, JANUARY/FEBRUARY 1956

Beaders~

Queries Answered by

Dr. A. D. Belilios K. A. (Norfolk) writes:In the recent amendment to the 40th edition of' First Aid to the Injured', it says under the heading: Fracture of the Skull- If breathing is obstructed in any way by blood, secretions or vomited matter, lay the patient on his side in the three quarter prone position. Could you say what position the patient should be placed in if breathing is 110t obstructed, would y ou suggest the 'old' treatment, e.g. lay the patient on his back with head and shoulders raised, also lVould it be advisable to turn the patient to the three-quarter prone position if say, he had a fracture of the lower limb , even after it had been secured by the method in the 40th edition.

Answer I would suggest lying flat with the head turned to one side, but careful observation must be maintained in case the tongue slips backward into the throat and causes difficulty in breathing. In the event of fracture of the lower limb as a combined injury, the amended treatment should still be carried out. T. F. W. (Storrington) writes:Treatment of Fracture of Skull Rule No. I

If breathing is not obstructed in any way whatsoever is it necessary to place patient in the three-quarter prone posit ion? If not, what position should he be placed in? Rule No.3 Unless the patient is on a stretcher or some other rigid (or semi-rigid) , bed' how is it possible for the head to be placed lower than the feet, unless, of course, there is a slope. It is assumed that the mere bending from the knees would not be satisfactory. General Rules Jor the Treatment oj Insensibility

Rule No.3

If a patient is unconscious due to

any reason, other than a head injury, and breathing is not noisy, in what position should he be placed? Should a desire to sleep still be encouraged except from those persons who are under the influence of drugs taken to relieve pain or 10 induce sleep.

Answer Treatment of fractured skull Rule 1. See K. A.'s answer above. Rule 3. In the absence of equipment such as you mention, mere bending from the knees would not, in my view, be satisfactory. I feel you should determine the cause of the choking and remove it, e.g. by mopping away secretion, blood, etc. General rules. See K. A.'s answer. A desire to sleep should be encouraged. A. E. (Western VaHey) writes:Please would you be so kind as to give your treatmenz or the version of the treatment in the St. John Black Book for a fracture of both legs, with no assistance. Trusting you will be so kind as to oblige as you did some time ago to a query I sent. Thanking you.

Answer Your question, accompanied by a description of the method you have been teaching, is answered in the Manual, P. 149d. There is no mention of the use of outer splints for this accident. A. F. W. (Esher) writes:Can you give me some information about the diagnosis and treatment of a broken nose please? I always understood it was a minor injury but recently one of my friends has disagreed with me.

Answer Pain, tenderness, bruising, swelling, deformity and nose-bleeding may all be present although one or more of these characteristics may be sufficient to make a diagnosis. Sometimes the chief injury is internal e.g. displacement of one of the bones within the nose. The general principles for the treatment of nose bleeding can be applied-so far as applicable-and a medical opinion is essential to prevent possible future impairment in the function of the organ.

J. B. V. (Ealing) writes:On P. 91 of the 40th edition of the S.J.A.A. book it says that blood carries the' oxidation product' (carbon dioxide) from the tissues to · the lungs. Would Dr. Belilios please explain the meaning of this word which seems rather technical?

Answer A fuel such as coal consists largely of carbon and burns by combining with oxygen; in this process a gas called carbon dioxide is produced. This is the' oxidation product', i.e. the result of a combination of carbon with oxygen. A similar process takes place in the tissues of the body.

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Answer This is due to bleeding under the nail and the blood cannot escape owing to the pressure of the nail, hence the pain. The condition is called a subungual haematoma. First aid is as for a fracture with special emphasis on a medical opinion since an X-ray may be required and the blood can be removed through a small hole made in the nail, thus relieving pain. Sussex Open-Continued judged, and Dr. Taylor-Young led the way. His chief criticism was directed to the manner in which the fractured spine had been treated, and he reminded the competitors that, above aU things, the back must not be allowed to sag in the middle, as he had seen more than one that day. For the rest, the work had been excellent, especially the treatment of wounds. Sometimes he had felt that the ingenuity of the competitors had been in advance of that of the judges. He had thoroughly enjoyed his day there. Dr. Matthews followed, and stated that he felt that in the individual (dual) tests some teams had fallen short of the usual high standards. The two competitors had not worked as a team. He reminded them that 'breathing barely perceptible' indicated artificial respiration. If necessary, this could always be carried out by one bearer. They had not considered sufficiently the four main points in the test which were all so significant: (a) He suffered from neuralgia, (b) His business was known to have been doing badly, (c) He was left-handed and (d) He was a collector of butterflies. In designing the test the emphasis had been on artificial respiration.

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A Review of 18 Months of Competition Work 2 Poisons 4 Research on Eye Diseases III the Middle East 6 Ealing Open Competitions 7 Police National Competition 8 Sussex County Competitions 8 9 Royal Review... Anterior Poliomyelitis 10 From a Seat in the Audience 10 First-aider's Crossword 12 Readers' Quer~es 14

Expert First Aid

A SHORT paragraph recently

appeared in the daiLy press describing very briefly an accident which occurred on the Fingringhoe Ranges, near Colchester, when Anthony Williams, aged 24 years, a Cadet sergeant-major in the London University (Territorial) Signals Unit, was shot from behind, and was given first aid by another non-commissioned officer, Cadet Sergeant Peter Pitt, of Reigate, who was highly commended by the surgeon at Colchester County Hospital. We called upon Mr. Pitt at Guy's Hospital, where he is a medical student, and found him awaiting the result of his Final, for which he had sat a few days before. Very modestly he explained what had taken place. He said that, by some unfortunate error the victim had received the shot in the back of the thigh (not the back, as reported in the press), causing dissolution of the femur at that spot

and creating a large cavity in the leg, from which the haemorrhage was severe. Without losing any time he applied direct digital pressure and instructed two men, neither of them first-aiders, to obtain two shelldressings which he pressed into the cavity, and, as soon as he was able to release direct pressure, he used bootlaces as a tourniquet. The patient was then transported to hospHal. Here was an excellent example of 'clear instructions to bystanders. ' When we left Mr. Pitt he promised that, as soon as he had received notification of his having passed out as a medical man, he would offer his services as a lecturer to the voluntary ambulance organizations who are so grateful to the medical profession, and without whose help their work would be impossible. St. J. and B.R.C.S., watch Mr. Pitt!

Casualties Union Honour Congratulations to the Cape Town Branch of the Casualties Union upon being presented with a Special Illuminated Vote of Thanks by the Priory of St. John in Southern Africa in recognition of their work in that part of the world. Mr. E. C.

ClaxtC)l1, M.B.E., B.Sc., A.M.LC.E. , Chairman of the Council of the C.U. remarked to us when discussing the award, 'It is something that we shall treasure as an indication that we are in some small way achieving the results we set out to do.'

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that • . . Sir Humphrey Davy, the inventor of the miners' safety lamp, first discovered the analgesic and exhilarating properties of nitrous oxide (1798) and called it ' laughing gas '? In the aorta the blood travels at 1 metre in 2 seconds, and in the capillaries at 1 millimetre in 2 seconds, but in the veins it travels at one-third the rate at which it travels in arteries of corresponding diameter ? 95 out of every ] 00 babies are born with dark hair ? Heroin (diacctyl-morphine hydrochloride) was discovered by Dreser in 1898 ? There are 5 million erythrocytes, or red corpuscles, per cubic mm. in the blood, but in anaemia the number may fall to 1 million ? The first painless operation under ether was performed by Crawford W. Long, an American surgeon, in 1842 ?

Thursday, 10th May, London Trans port Ambulance Centre, Presentation of Awards, Social, Cabaret and Dance, Porchester Halls. Saturday, 26th May, Girls' Life Brigade Finals, London. Sunday, 27th May, National Road Passenger Transport Ambulance Centre, Southern Area Competitions. Birmingham. Thursday, 31st May, Distillers ' Company, Ltd., Ambulance Association, Finals, London. Saturday, 2nd June, British Red Cross Society Finals! Friends' Meeting House, Euston Road. Thursday, 7th June, British Transport (Railways and Docks) and B.T.C. Police Finals, Central Hall, Westminster. Friday, 22nd June, Ministry of Supply Ambulance Centre Finals, Central Hall, Westminster.

Saturday, 30th June, St. John Ambulance Brigade Finals, Senior and Cadet, Central Hall, Westminster. Sunday, 8th July, National Road Transport Ambulance Centre Finals, Aldenham L.T.E. Wednesday 1st to 8th August, National' Save-a-Life ' week. Friday, 28th September, .National Fire Brigades Fi nals, Hastll1gs Tuesday, 2nd October, Gas Industry Ambulance Finals, Conway Hall. Wednesday, 24th October, G.P.O. Ambulance Finals, Porchester Halls. Thursday, 15th November, Grand Prior's Trophy, POl'chester Halls. NOTE We apologize to readers for t~e delay in the publication of this issue, but ~hJ~ has been due to a recent dispute in the pnnting trade.

FIRST AID & NURSING, MARCH/APRIL 1956

The author contends more attention should be paid to the individual and dual tests· he analyses the comparative importance assigned to various types of injury by the judges, with surprising results; and finally he examines the value of competitions to the whole lVIovement.

A REVIE\V OF 18 MONTIIS OF ~OMPETITION WORK This kind of sortie 'ALRIGHT, we're first-aiders,' and four men rush forward and pounce upon their victim Ii ke a pack of wolves attacking the carcase of a fallen sheep, helpJess to defend itself. I cannot help feeling that, were I the patient, even jf I were not already sufferin g from traumatic shock, the direct effect of the accident itself, I would immediately develop nerve, haemorrhagic and toxic shock combined as a result of sheer fright. Yes, week after week during nine months of the year we are witnessing this kind of sortie a dozen times in a day. Moreover, examination of the marking sheets discloses that, with very few exceptions teams obtain full marks for this first item,' usually descri bed as ' Approach', sometimes qualified by such adjectives as . rapid' or 'quick.' Whom shall we blame, the text-books? I have before me quite a nwnber, but let us see what the three official ones h ave to say upon the questlOn of approach. (a) , Respond quickly to calls for assistance,' (b) , Go immediately to the a id of the casualty' a nd (c) ' The treatment, furthermore, is immediate ' and ' Tmmedi a te atte ntion may mean actually saving a life.' Now, what of the unofficial text-books? The fi rst one I pick up emphasizes the importance of speed by heading its first chapter' Immediate Aid.' Another advises One well-known ' D eal at once, etc.' writer on Competitions says, ' When the acci dent happens act promptly. ' A textbook which sets out to teach ' Advanced First Aid' reminds the student that ' Speed is essential. ' An American text-book urges , You should act quickly' but quaLifies this by adding, ' but not with too much haste,' and a German text-book emphasizes the importance of wasting no time. It must be admitted that this emphasis on speed in dealing with the incident is justified, and the fau lt , therefore, lies in its interpretation. This question of approach needs much careful study. Lurking behind the door Unfortuna tely, this' att ack' approach is not confined to the competition hall . It is to be seen in the roadside first aid post, the beach hut and the casualty station on the fete ground. Three or four nurses will be found lurkin g behind the door in a ' Come into-my-parlour' attitude, and woe betide the poor victim who is unfortunate enough to need attention. He enters the trap , and immediately he is fallen upon by the whole of the .pack, pushed into a chair and subjected to an infernal inquisition by three or four nurses, a ll talking at once. Compare thi s 'With the procedure in the casualty department of any general hospital. The patient enters, and immediately he is approached by ONE nurse in a quiet and dignified manner. She may be the one who h appened to be nearest the door when the patient entered or she may have been

By F. C. Reeve, F.Z.S., F.R.E.S., F.I.C.A.P.

disengaged at that moment. She listens attentively to what th e patient has to say, books him in, compressing his disability into one or two words, hands him a card and pilots him to the casualty officer who diagnoses his trouble, writes the prescription on the card and tells him that one of the nurses will attend to him. Outside the consulting room he is again approached by ONE nurse who quickly and efficiently deals 'With his case. 1 have gone out of my way to describe casualty procedure in order to emphasize the f 8 r t that, with few exceptions, such as a plaster case o r undressing an unconscious or seriously wounded person, it is only necessary for ONE nurse or bearer to attend a patient. Composition of a team This naturally leads to a consideration of the composition of a team. During the period of 18 months from and including tbe , Stanley ' in May, 1954, ;p to and including the ' Grand Prior ' in November, 1955, I attended 32 major competitions, a nd it is these that I am PfGPo ~i ng to pass under review, with a view to discussing the lessons to be learned from them and their value to the ambulance and nursing movement as such. From the marki ,:g sheets of these competitions which I h ave before m e it would appear thal in a very large proportion of the team tests the judges have created one major injury a nd one, two , or perhaps three minor ones. Sometimes there may be an additional ' patient ', but his or her injuries are usu a lly of a very insignificant character. Tilis seems to have become more or less an established pattern. Now, for a test such :::.:; the above, two bearers would be quite sufficient. If more than this number are employed they are only getting in each other's way, a fact which is demonstrated at every competition we witness. Diagnosis can only be carried out by one bearer, although we often see two, or even three, attempting to do this at the same time. This is definitely the function of the team leader, and until this is completed little can be done except' removal of cause. ' and 'prevention of further aggravation.' Watch that team of four members and it will be noted that, for the first minute or two of the test, two or three of them are actively busying themselv.:::s doing absolutely nothing. Now the action of the test really commences. It is only necessary for the team leader to possess a thorough knowledge of the text-book , the remaind.e r being, as a rule, employed upon tasks, under his direction which, for the most part, require no technical skill, and could have been carried out by any intelligent bystander. I qualified this statement by saying, . for the most part.' There are, of course, a few exceptions, such as preparing and blanketing stretcher, making a cold compress, etc. The question, therefore, cannot be avoided: ' Is too much emphasis placed upon

the team test?' The first-aider trains in order to prepare himself to be of service to his fellow-creature in cases of emergency. How often is such an emergency likely to arise just at the moment that four trained competition men happen to be passing together? Even on public occasions ambulance men and women are usually sent out to patrol either singly or in pairs. In the factory, on the railway, down the mine or in any other circumstance it is extremely unlikely that four could be collected at a moment's notice. No, I cannot avoid the conclusion that more attention should be paid to the individual and dual tests, despite the fact that the team tests are far more spectacular, and, therefore, attract the larger audiences at the competitions.

Alter its character It will probably be suggested by many that the team test is an excellent preparation for dealing with major disasters . In the schemc described by Major-General L. A . Hawes, CB.E., D.S.O., M.C, M.A., Controller, Home Department, British Red Cross Society, at the Barnett Hill Conference which, through his courtesy, I was privileged to a ttend, and to report fully in the columns of this journal la<;t year, there would be, I am sure, no room for the team as such, and as at present constituted. At the same time I am not advocating the abolition of the team test. Preserve it by all means, but alter its character. Let the staging represent a major disaster in miniature, with half-a -dozen casualties scattered all over the place. This would call for the same organization and leadership, but of a much higher standard, and would prove a stepping-stone to the collective training now being worked out by Major-General Hawes. It has been very interesting to note the comparative importance assigned to various types of injury by the judges, assuming that this is accurately represented in the following analysis of injuries in the 32 competitions under review. It is compiled from team, dual and individual practical tests. No particular order is observed in presenting the items, the items appearing in the order in which they were worked out:

ANALYSIS OF INJURIES Contusions: 16, of which 6 were 'head, 5 forehead, 2 abdomen (one involving the liver). Lacerated wounds: 17, of which 4 were sca lp, J forehead and 1 temple. Fractured bumerus : 9, of which 4 involved elbow and 1 was complicated. F .B. in eye: 4. Fractured tibia and fibula, not described as Potts': 5, of which 4 were compound. Incised wounds: 25, of which 2 were accompanied by haemorrhage, 2 with F.B., I described as head, I as forehead and 1 as scalp .

FIRST AID & NURSING, MARCH/APRIL 1956 Fractured fi bu la: 5. Shock: 53, of which 6 were electric, 3 were nerve, 1 nerve and haemorrhage, ] haemorrha gic, J with fainting and 1 delayed from burns. Fractured scapula: 2. Dislocated elbow: 5. Infantile convuls ions: J. Compression: 7 (apart from those which had developed from concussion). Concussion: 20, of which 3 developed into compression. Fractured patell a: 12. Penetrating wounds: 2 chest (I sucking) , 3 abdomen, 2 gunshot. Internal haemorrhage: 5. F.B. in wound: 5. Potts' fracture: 8. Fractured jaw: 7, of which I was both sides. ] nsulin overdose : 2. Fractured femur : 12, of which 5 were neck and 1 complicated. Dislocated shoulder: 5. H aemorrhage (apart from that associated with specified injuries): 22, of which 1 was tooth socket, I scalp and 1 with F.B. Asphyxia: 18, of which 10 were CO (5 coke fire), 1 described as' partia l,' 1 baby, and I drownee. Scald: 9. Fractured rib: 10, of which 2 were 8th an d 9th, J was 7th and 8th , 1 was 3rd a nd 4th , a nd I was a crush in vo lving 3rd, 4th, 5th and 6th . Fractured tibia: 12, of which 3 were compound including 1 case of both tibiae. Fractured sk ull: 6, of which 3 were depressed . . Fractured ra diu s and uln a (not descnbed as Colles'): 2, 1 of which was compound . Abrasion: 12, 1 with contusion, 1 with haemorrhage and 1 on forehead with F.B. Colles' fracture: 9. Fractured clavicle: 11. Faint: 1. Apopl exy: 3. . . Fractured spine : 6, of WhICh 2 mentlOned vertebrae and I in lumbar region. Fractured radi us: 4, of which 2 were compound. Spra ined ankle: 9. Uncon sciousness: I . Epilepsy: 5, of wh ich I was mi nor. Poisoning : 2, of which I was aspirin. Dislocated jaw: I. Drunkenness: J. Fractured base: 6. Hysteria : 3. Fractured pelvis: 6, of which ] was complicated . Abdomin a l inj ury: I. Crushed foot with lacerated wound of instep: I. Varicose vein: 1. Fractured carpels : I. Diabetic coma: 3. Fracturcd lcg (?): 4 . Epistaxis: 2. Sprained knee-joint: I. Strained mu scles: 4, of which 2 were calf, 1 back and J shoulder. Crushed finger : I. Tennis elbow: 1. • Stitch': 1. Angina: 1. Fractured middle phal a nges of 2 fingers: I . Inju ry to tongue : I. H aemoptysis: 2. Brush burn: 1. , Winding ' or blow on solar plexus: 1.

NURSING TESTS Assist in and out of bed: I. Laying up trays or troll eys: II , in cluding 1 mouth a nd I H.T. , both of which h ad to be given. Adjust position and' tidy bed': 1. Take and chart T.P.R.: 2. Bedmaking: 3. A rra nge a steam tent: I . Change undersheet: 2 (an d draw sheet in one case). Change draw sheet: 1. Change top sheet: 1 (measles). Attention to rheum atism case: ]. Attention to laryngitis case: I . Prepa re room for measles: 1. Blanket bath: I . Occasio nal a pplication of roller bandage. Amazement Perha ps the first reaction following a study of this analysis wi ll be amazement at the prominent position occupied by fractures, which appear in no less than 141 tests. In m y early trai nin g I was taught to regard this subject as of paramoun t import ance, doubtl ess the result of the teachings of such wr iters as Drs. Shepherd, Scott Riddell, Schafer (translated by Princess Christian) and Cantlie. Today, however, I would have expected to find the emphasis on those three giants, Haemorrhage, Asphyxia and Shock. In my analysis I found 27 cases 01 external haemorrhage, 7 cases of internal haemorrhage (although it is to be assumed that haemorrhage accompanied a number of other injuries without being specially mentioned, bearing in mind that a compound fracture is not necessaril y accompanied by haemorrhage), 53 cases of shock and 18 of asphyxia. Of cases re::tuiring artificial respiration I note, somewhat to my horror, that only one was a drownee. Judges, please pay more attention to this class of accident, especially as the' Save-a-L ife ' week, inaugurated last year by Lieut-General Sir Otto Lund, K .C B. , D .S. O ., r::ommissioner-in-Chief of the St. John Anbulance Brigade, is, he informs me, to be established as a permanent annual institution. Diagnosis I opened this survey With. a critical examination of thc first Item which appears on nea rl y every nrst aid marking sheet. Space forbids my treatment of all. the it~ms in a simil ar manner, but I WIll briefly comment upon a few points which have occurred to m e time after time as I have watched the teams at work. Perhaps the first to warrant attention is the question of Diagnosis. You cannot give satisfactory treatment un til you have arrived at a correct di agnosis, and this can only be obtained as a result of a METHODICAL examination. Diagnosis is definitely weak, and I would refer students to my series of articles upon this subject to be found in the four numbers of First Aid af7d Nursing from May June, 1953, to the e~d of ~he year. These back numbers are stdl ava il able. Ineffecti ve gestures Many of the procedures carried ou! in competition are mere gestu res a nd would be absolutely ineffective in an actual case. Judges should pay particular attent ion to these and should not hes it ate to debit marks if not completely satisfied. Observation needs cultivating. Try to take in as

many details as possible upon entry. Instead of concentrating exclusively upon the patient, study as rapidly as possible the surroundings in order to get a thorough grasp of the whole situation. Stretcher drill is generally weak except by police teams. I would like to see less 'spoon feeding' and more imp·rovisation . Every experienced team knows that a piece of wood cut and shaped to serve as a Liston splint is just out of sight. A hurdle has been prepared all ready for use as a stretcher. and every nursing team knows very well that fracture boards, cut to length, are hidden behind that door. Above all things, try to re31ize that you arc treating a human being in distress and not mending a table or repairing a car. Your patient, if conscioLls, can not only see and hear, he can FEEL. Talk to your patient. Tn surveying the progress of competitions during the first half of the present century, tribute must be paid to those who have ma1e so many contributions to the realism with which they are staged today. The • patients' and make-up artists (' fakers '), trained by the Casualties Union, St. John and the B.R.C.S., and those film companies, Ii ke the Associated British Picture Corporation Ltd., and others who, realizing the value of first aid and nursing to the community. have been unstinting in their desire to assist.

Any material benefit? One question still remains. What effects have the competitions on the movement as a whole? Is the movement receiving any material benefit? The answer is, undoubtedly, yes, but it could receive more. Suppose we visit a division or detachment on a practice night. Four of the best men or women are segregated from the class and allowed to go into an adjoining room, where an intensive training is carried out. In course of time these four become experts, but they have by now evolved into a separate entity, with. ~nIy a nominal connection with the diVISion or detachment. If the full value o[ their training is to be reflected in the whole class, then these individuals mllst be used as demonstrators and lecturers to the remainder of the class. Here, however, we are up against the human element. Although the superintendent or commandant may, secretly, be fully aware of the fact that these competitors are far more efficient than he or she, considerable moral courage would be requi red to admit it, and this is the proble~n which has to be faced. Perhaps a step 111 the right direction would be a rule compelling No.1 to rcLire at the end of the year, his place being taken by o. 2 and the remainder of the members moved up In order to admit a new [\;0. 4. This, however, is only a partial solution. The spirit A word about the spirit in which competition are entered. Try to realize that the competition is not the end, but ~ ~neans to an end. Look upon the competllion ~s a stimulus to improve efficiency which ~11l the better enable you to serve hum~~lty, which, after all, is the objec.t of our trall1lng. This is the motive underlxmg the pollcy of First Aid and NlIrsil/.f(. It IS an mdependent journal whose sole object is to promote the interests of the MO\ement as a movement, COlltil/lled 011 next page

FIRST AID & NURSING, MARCH/APRIL 1956

A Course in Elementary First Aid

Poisons By A. David BeliJios M.B., B.S. (Lond.), D.P.H. (Eng.)

The last article in this series was concluded by giving a classification of poisons and it is now proposed to describe more ful1y the characteristics of each group. Corrosives THESE burn parts of the body 'with which they come into contact. They include strong acids and alkalis. An acid is a chemical which in solution usually has a sour tftste. It can be readily recognized by its effect on a small strip of paper coloured blue and called blue litmus paper. An acid changes this colour to red. Examples of common strong and corrosive acids include Sulphuric (oil of vitreol), Hydrochloric (spirits of salt) and Nitric. Alkalis have the reverse effect on a piece of litmus-turning the colour of a red paper to blue. Examples include caustic soda, caustic potash and ammonia. Particularly severe symptoms are caused when corrosive poisons are swallowed. There is intense pain along the course of the food passages -mouth, throat, neck and abdomen. This pain produces profound shock and there is retching and sickness, the vomit often contairung blood. The lips and mouth of the pa6ent are burned and stained- indeed a similar condition affects other parts of the digestive system, i.e. the red lining or TImcous membrane of the throat, cesophagus, etc. Sometimes there is danger of asphyxia through swelling of the tissues of the throat and respiratory system particularly if the poison gives off [urnes which are automatically inhaled, e.g. hydrochloric acid. Equally serious is that the corrosive may so weaken the coats o[ the oesophagus and stomach that these organs will perforate, permitting their contents to scatter in the abdomen causi ng further complications and burning. For this reason it is of the greatest importance not to give an emetic in this variety of poisoning since vomiting adds to the risk of perforation.

First Aid The first step is to give an antidote which is a substance that will neutralize the effect of the poison that has been taken, converting it into a comparativc:y harmless substance. When, for example, an acid is mixed with an alkali the two chemicals neutralize each other. Thus, oil of vitrrol mixed with caustic soda produces glauber salts and water. Naturally, however, strong acids and alkalis are not used as antidotes for they themselves will do harm before neutralization takes place. For corrosive acids, antidotes suitable include PQ\"r!ered magnesia (two tablespoonsful) or powdered chalk stirred up in a pint of water; a pint of soapy water can be given as an alternative. For corrosive alkalis two tablespoonsful of vinegar (dilute acetic acid) lemon or lime juice, citric or tartaric acid (two teaspoonsful) again dissolved in a pint of water can be administered. Carbolic acid (phenol) and disinfectants which SPl.t' l l of this acid are also considered corrosive poisons although their action 011 the human body is a little different from those above described in that they tend to harden the tissues with which they come into contact as well as causing burns. For these, the best antidote is about half a pint of liquid paraffin and this also acts as a demulcent. Alternatives include one tablespoonful of Epsom or Glauber's salts dissolved in half a pipt of water. The trouble with antidotes of course is that they are generally not at hand when needed. In their absence demulcent drinks, i.e. fluids which sooth the burnt tissues must be given freely. These should be given in any case after the antidote and include milk in particular, barley water, olive or salad oil, liq uid paraffin, etc. Shock, of course, must be treated and the general principles of first aid applied so far as applicable.

Irritants These irritate rather than burn the parts with which they come into contact although sometimes the dividing line between this class of poison and the corrosi ves is fine. Irritants include bad meat, decaying fish, certain fungi and berries and a large number of chemicals such as iodine, arsenic, phosphorus, mercury, etc. Naturally the symptorns caused by ingestion vary with the poisons that have been taken. In food poisoning, for example, pain in the stomach 18 Months of Competitions-Con tin lied and holding no brief for any individual organization . It fulfils a special function. By concentrating upon reporting and commenting upon the major competitions and publishing technical articles it seeks to complement the valuable work of the Red Cross Qllarterly, the St. John Review. Ambulance (the organ of the Institute of Certified Ambulance Personnel) and the

Casualties Union Journal. First Aid and Nursing must not be regarded as a subst!tute for . any of the above journals, Without which the members of the respective organizations would find it difficult to keep informed of the activities of their respective bodies. We ask our readers to take their respective journals as wel l as First Aid .and Nllrsing, and they will find that by thiS means they can keep themselves right up-to-date, both in technical matters and in the domestic affairs of the body to which they belong. No new and revolutionary cult Finally, let me emphasize that this article is not to be interpreted as an attempt to introduce a new and revolutionary cult into the competition world, but simp ly the expression of a few suggestions from one who, through the courtesy and tolerance of the organizers, has been fortunate to have facilities for studying at close quarters details and conditions not always apparenl to the average spectator. 1 am fully aware that much of what I have written will meet with disapproval by many of our readers. This is all to the good, a nd I hope thal you will not hesitate to let me have your criticisms, for the article is intended to be provocative. It will, however, be fully appreciated that pressure on our space would prevent the development of any discussion on the subject. Perhaps later in the year, when competition reports demand rather less space than at present, I may have a n opportunity of summarizing the correspondence which L trust will be stimulated by this survey.

FIRST AID & NURSING, MARCH/APRIL 1956

region of the abdomen begi ns soon after taking the meal and is of a dull aching character. Nausea, retching and vomiting follow and may terminate the attack by emptying the stomach. Often, however, the poisonous substances enter the intestines and the patient develops severe abdominal pain of the colicky type, commonly known as griping. This is accompanied later by diarrShock and collapse may hoea. occur. Symptoms caused by swallowing one of the chemical irritants are usually more drama tic and come on quickly. Thus there may be an immediate burning pain in the mouth and food passages, followed by vomiting, abdominal pain and diarrhoea. The vomit may contain blood while staining of the mouth and mucous membranes may be present in certain cases. Treatment The first step is to induce vomiting either by tickling the back of the throat or by giving an emetic. The reason for trying 'tickling' first is that it is a method that can be more quickly applied than obtaining and preparing a solution of salt or mustard in water. When vomiting has ceased the antidote for the poison must be given. As has been previously explained, however, the specific antidote is often not readily obtainable and in this event demulcents must be administered. Some authorities advise giving a dose of castor oil before the demulcents but S.l.A.A. students are advised not to do so except under medical supervision. The treatment of shock and the application of general principles must be carried out. Narcotics These act upon the nervous system after being absorbed into the blood stream producing a tendency to sleen which may lead to coma. They a'rso tend to reduce the activities of the bodily functions. The narcotics can be divided into three main groups-the barbiturates drugs which are commonly used in these days to produce sleep, e.g. soneryl, medinal, and many others, opium and similar drugs used to relieve pain, and alcoholic drinks taken to excess, e.g. spirits, beer, wine, etc. Symptoms and signs vary

according to the d rug that has been taken. Barbiturate Drugs Symptoms and signs of overdosage with a barbiturate drug come on quickly. The patient becomes increasingly drowsy and soon falls asleep, becoming comatose. The pulse is quick and feeble, the skin cold and clammy while the: face becomes pale, often with cyanosis of the lips, ears, cheeks, etc. The first step in the treatment is to produce vomiting but this must be undertaken well before unconsciousness supervenes, otherwise there is a considerable danger of asphyxia caused by the inhalation of vomit or through the emetic that is being given passing down the passages of the respiratory system. When the emetic has ceased to act strong coffee to which glucose has been added can be given with advantage provided once again that the patient is not unconscious and is well able to SWallow. It is more usually the case, however, that by the time the patient is discovered he is ina state of stupor or coma. In this event the firstaider must apply the general rules for unconsciousness being prepared at any moment to begin artificial respiration and to administer oxygen if available. There can be no doubt that a hospital is the place for these patients where there is every facility to hand, a stomach wash can be given by an expert, special antidotes administered by injection and a procedure such as lumbar puncture undertaken if considered advisable. The latter comprises releasing from tILe body cerebro-spinal fluid by inserting a needle into the spine in the lumbar region. Opium This is one of the pain relieving drugs from which are derived important preparations such as morphia, codeine, various cough and diarrhoea mixtures also contain the drug. Overdosage produces a picture very like that of poisoning with a barbiturate. A characteristic feature is that the size of the pLi pils become minute-a sign called pin-point pupils. All the bodily functions tend to be slowed down. Thus the pulse is

slow and feeble, the breathing slow and shallow ultimately becoming of the cheyne-stokes type. As unconsciousness deepens, the face becomes bluish, the limbs and the skin moist and clammy. Treatment is very similar to that for poisoning by a barbiturate. If the antidote (potassium permanganate or condy's fluid) is immediately available it should be given before producing vomiting provided of course that the patient is conscious. It may be repeated after vomiting has ceased. Sometimes it is not possible to produce vomiting owing to the sedative action of the drug upon the stomach. Otherwise the general principles for barbiturate poisoning should be followed.

~¥ational

Hospital Service lleserve

Brighton Annual Reunion " It is always a pleasant sight to see the uniforms of the British Red Cross Society and the St. John Ambulance Brigade mingling together, whether on duty or at a social function. One of these occasions was the Annual Reunion of the Brighton National Hospital Service Reserve, which was held in the Recreation Room of the Nurses' Home of the Brighton General Hospital, through the courtesy of the Matron, Miss J. Love, S.R.N., and the nurses who so generously agreed to its use. Before entering upon the social events of the evening the members and their friends were privileged to listen to a most interesting illustrated talk by Miss C. Shaw, who was introduced by Miss K. Ward, S.R.N., M.C.S.P. , County Director, B.R.C.S., for Sussex. In reviewing the Annual Report of the British Red Cross Society some time ago we referred to the activities of the Society abroad. Miss Shaw, the newly appointed Divisional Director of the Brighton and Hove Branch spent some time as the Society's representative in Korea. Emphasizing the many difficulties which she and her two companions had to face, Miss Shaw proceeded to explain the work of nursing and welfare amongst the sick and the refugees, often without t.he advice of any medical man. The descnption of their fight against tuberculosis, which was the great curse of Korea, and their endeavours to raise the standard of living, often against tremendous odds, was most stimulating. Pictures were shown of the hospital, the sanatorium for c~ildren and the nurses who had assiste~ iO tJ:lis great work. Despite all the difficulties they encountered, Miss Shaw concluded by saying that she felt that she had been most fortunate in having had such a grand opportunity. . A vote of thanks to MISS Shaw for her most interesting lecture was proposed . by Councillor A. W. Briggs, of the Hospital Management Committee, and supported by Dr. S. J. Firth, Hospital Group Officer, ~nd both wished her success in her new capacity.

FIRST AID & NURSING, MARCH APRIL 1956

RESEARCH ON EYE DISEASES IN TIlE

~IIDDLE

EAST

Order of St. John Extend Facilities and Research OF the great Orders of Chivalry which existed in the Middle Ages, the Order of the Hospital of St. John of Jerusalem is the only one which today has descendants who still carry out the objects for which it was originally founded- the relief of suffering of the sick and injured in peace and war, irrespective of cl ass, race or creed. Origin of the Order Legend has it that in order to provide much needed succour to the pilgrims who had journeyed to the Holy Land from Western Europe, a t the beginning of the seventh century a Hospice was instituted in Jerusalem not far from the Church of the Holy Sepulchre on a site which is still in the possession of the Order in the Old City of Jerusalem today. There is also a story that 400 years later it was destroyed by the mad Caliph, EI H akim; but it is known that during the first half of the eleventh century the wealthy merchants of Amalfi rebuilt and re-established the Hospice for Christian pilgrims to Jerusalem, placing it in the care of a group of Benedictine monks. The Hospice was dedicated to St. lohn the Almoner, and those who ran it became known as the Brethren of the Hospital of St. John of Jerusalem. When Godfrey de Bouillon led the First Crusade into Jerusalem in 1099, he found the Hospice in full working order and many wounded Crusaders received help and attention from its Brotherhood. The fame and popularity acquired by the Hospice at this time enabled the leader of the Brotherhood, the Blessed Gerard, to free it from Benedictine rule and establish a new Order of Hospitallers who devoted themselves to the care of the sick and poor. Under his successor, Raymond de Puy, the Order of St. John was militarized and combined its charitable activities with that of fighting in defence of the Christian Faith. Thus was the Order of the Hospital of St. John of Jerusalem established and the military exploits of the Knights Hospitallers became legendary' but they still retained their vows of poverty' humility and piety while providing luxury for' our lords the sick ' . This combination of a spirit of heroism and service was epitomized on the fall of Acre to the Saracens when the Sisters of the Order died at their posts nursing the wounded rather than accept the offer of escape by sea. In 1291, when the Christians were e~pelled from the Holy Land, the Hospltallers were forced to abandon their work there and re-established themselves in Rhodes and later Malta. The latter was finally lost to Napoleon at the end of the eighteenth century, but the Knights of St. Jo~n have survived. Their English branch, whIch was suppressed by Henry VIII in 1540, was revived in the early nineteenth century and became the Venerable Order of the Hospital of St. John of Jerusalem being granted a Charter by Queen Victori~

in 1888.

Ed,vard VII, as Prince of Wales, des.ir!~g to resuscitate the charitable actIVItIes in the Middle East, in 1882 obtained a house from the Sultan of Turkey on the Bethlehem Road, Jerusalem, and there, in view of the fact that eye diseases were the greatest social scourge in the Middle East, an ophthalmic hospital was opened and maintained by the Order. Since that day this charitable work has been continued, although, as with the hospital which preceded it seven centuries before, its history has been chequered. Used as an Ammunition Depot The Hospital flourished and its work exparded until the First World War when it was cccupied by the Turks and used as an ammunition depot, but on Field-Marshal Lord Allenby's advance upon Jerusalem, it was blown up by them and considerably damaged. The Order, however, quickly repaired the damage and Lord Allenby re-opened it in 1919. Thereafter, under the Wardenship of Sir John Strathearn, it rapidly expanded, increasing its accommodation by building on adjacent land gifted by the Greek Patriarch Damianos in 1921 and 1925, and increasing its activities by setting up clinics in outlying areas of the surrounding country and founding and maintaining in Jerusalem a school for the training of Arab nurses. In 1948, however, when the Arab-Jewish hostilities Croke out, the Hospital became a strategic point in front .. lire fighting and had to be abandoned. The Order thereupon opened a temporary hospital in its property in the Old City of Jerusalem, close to the site of the original Hospice founded 13 centuries previously. There it is still continuing its work,it is true under considerable difficulties, but yet efficiently. To the vast Arab population in this region swollen by hundreds of thousands of refugees, a population materially poor and with the highest incidence of eye disease in the world, it is the onJy source of relief. During the past year it recorded the astonishing figure of .183,000 out-patients, many of them travellmg for days to reach the hospital, and its 45 ceds are overbooked to such an extent that the waiting list for admission for operation is 9 months for a male, J 3 for a female. New and I.arger Hospital In view of the inadequacy of the present premises, the Order has decided to build a new and larger hospital for which a site has now been bought, and building plans are far advanced. But it has decided to do more than this. Hit1,erto the hospital has treated those who are already diseased and blind; the intention is now to promote :esearch not only so that treatment may be Improyed but that the blinding diseases so prevalent in this part of the world may be prevented.

A Quarter of the Popul a tion of the World suffer from this Disease The most universal eye disease throughout the Middle East is trachoma, and this, in association with the acute epidemics of ocular infections that sweep the area seasonally, is responsible for most of the blindness so prevalent in the country. Trachoma is not confined to the Middle East; it has a widespread distribution, stretching from Central and South America, across Africa and South Eastern Europe, through Central and Southern Asia to Japan on the one hand and ] ndone~ia and Australasia on the other; it is estimated to affect a quarter of the population of the world, and certainly causes more visual disability and blindness than any other disease known. In the Middle East it is seen in its most viruJent form, being contracted usually in infar..cy; sometimes it burns itself out, but more often, if it is untreated, the sufferer is condemned to a life of inteJmiltent pain and disability and too often becomes blind. It is a tale of immeasurable human suffering and vast economic loss. Until recently it was treated by much the same methods as we learn from papyri were practised by the Ancient Egyptians some 4,000 years agoby cauterization with copper and other metals. Recently the new antibiotic drugs have made therapeusis much more effective -but none of the~e is specific. The disease, however, is due to a virus; and in the last few years techniques have been evolved for the cultivation and manipUlation of viruses which for the first time give rise to hope that this scourge may be brought under control. For these reasons the new hospital projected in Jordan is to assume a r.ew aspect. Instead of a hospital fitted for dealing with the local sick poor, the intention is to transform it into a hospital equipped for investigative work in association with a Research Institute which will be capable of co-ordinating a campaign against ocular disease throughout all the neighbouring countries in the Middle East. Jordan was specifically chosen as the centre of the research owing to the presence of some 400,000 refugees in the neighbourhood, most of whom are infected by trachoma; these will form an ideal static community wherein to conduct controlled research. For this purpose generous financial support has been given by Her Majesty's Government through the Colonial Development and Welfare Fund and the Wellcome Trustees; the Colonial Office is interested in the scheme owing to the vast number of British subjects affected by trachoma, particularly in Africa, for any results emerging from this research will, of course, find universal application. At the same lime an appeal launched by the Order primarily to business interests in the Middle East has met with a heartening response, particularly by the oil companies working in the area. Generous support has a lso been given by the Rulers of Kuwait and Bahrein and the Government of Jordan, while W.H.O. and particu larly U.N.R. W.A. are co-operating and have made contributions. At the present moment a virus laboratory is being builtin Jordan which it is hoped will be completed and working in the near

Continued at bottom 0/ next page

FIR ST AID & NURSING, MARCH APRIL 1956

Eal;'1fI Ope., CO.,,]Jf! ti t iOlf,S D ESPITE the difficulties presented by lack of uniformity in text-books, methods of training, etc., the open competition is rapidly be<:oming an establish.ed institution. The EalIng Ambulance DIVision, No. 85, S.l.A.B., which was one of the pioneers in this direction, held its tenth Annual Open Competitions in the Ealing Grammar School for Boys, Ealing Green. Separate tests had been set for each of the dozen trophies, and as they were all held in different rooms of the School. The spectator who wished to witness as much of the event as possible was kept pretty active. Owing to the size of the Competition at the present time, it was necessary for the Finals of the Gow, Widdowson , Florence and Caldwell to take place on a date previous to that of the main event. Space prevents LIS from describing the Individual tests, but the four Team tests were as follows: . EALTNG CHALLENGE CUP The team witness an accident in which an elderly cyclist falls on a zebra crossing. He is found to be suffering from a fracture of neck of right humerus, lacerated forehead with capillary bleeding, twisted right ankle and shock. The test was set and judged by Roger S1. .John Buxton, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H., Divisional Surgeon, No. 199 Banstead, S.J.A.B. BAR CLA Y SMITH TROPHY A woman has both hands trapped by a falling window sash, but is rele~sed by a neighbour just as the team arnves. She falls back, knocking her head and ribs, and also brings down a quantity of crockery. She is unconscious and sustains a contused wound on back of head, cut on temple, severe cut on right arm with glass embedded, fractured ribs and swelling on wrists. The test was set and judged by G. M. Shaw Smith, M.B., Ch.B ., D.P.H., Area Commissioner, Northern Area, S.J.A.B. ARTHUR FENTON CUP Patient accidentally fires a revolver, and bullet passes right through his chest. .Other injuries, partly sustained in fall:. brUise on right temple, powder burns on nght hand. There is severe internal haemorrhage. The test was set and judged by Lt.-Col. F. Hayden-Taylor, O.B.E., M.D., B.S., B.Hy., M. R . C.S., L.R. C. P., D.P. H., D. P. M.) D ivisional Surgeon, No. 99, Lambeth, S .J.A.B. WILLO UGHBY GAR NER CUP The team is in a fishing boat when a man falls overboard. He is asphyxiated, th.e fluke of the anchor has penetrated hiS chest and he has a fractured leg. The test was set and judged by Lt.-Col. E . J. Selby, O.B.E., M.A. , M.R.C.S., L. R .C. P ., Deputy District Surgeon, No. I D istrict, S.J.A.B. ., Judges in the remalnlDg tests were: C. A. Osborn, M.R.C.S., L.R.C.P., D ivisional Surgeon, No. 134 Greenford, S.l.A. B .; C. J. P. Seccombe, M.R.C.S., L. R .C.P ., Area Surgeon, Western Area. SJ.A .B.; A. Conn, L.R.C.P.&S., L. R .F.P .S., Area Surgeon, South Western

Area, S.J.A.B.; H. Mandiwall, M.B., B.S., L.D.S., Divisional Surgeon , No. 19 Heston and Isleworth, S.J.A.B.; Hermia Mills, M.B., B.S. (London), M.R.C.S., L.R.C.P., Divisional Surgeon, o. 144 Highbury Divisio!1, S.J.A.B.; M. H. Barley, M.B., B.S., Divisional Surgeon, o. 17 Wimbledon, S.J.A.B.; Dorothy Gibson, L.R.C.P. &S., Divisional Surgeon , o. 22N Harrow, S.J.A.B.; J. C. Turner, M.B., B.S., Divisional Surgeon, No. C7 Southall, S.J.A.B. The Referees were Major G. E. B. Payne, M.D., M.R.C.S., L.R.C.P., D.P.H., Area Surgeon, Western Area, S.J.A.B., and Dr. Seccombe (also a judge). At 6.50 p.m. the Mayor of Ealing, Councillor Mrs. Grace Ainsley, arrived. Divisional Superintendent G. L. Smith, presiding at the presentation, said that. it was his pleasant duty to welcome Major A. C. White Knox, O.B.£., M .C., M.B., Ch.B., Surgeon-in-Chief, the St. John Ambulance Brigade, who had so kindly undertaken to present the trophies. He also extended a welcome to all those who had accepted invitations to attend that day, including Ald. W. J. Gooderham (Deputy Mayor of Ealing), Mr. John Barker, M.P., Surgeon Rear-Admiral R. L. G. Proctor, Major-General A. Sachs, Group-Captalll J. B. Wallace, Lt.-Col. A. R. T. Lundie, Col. L. G. Irvin (U.S.A.F. Hospital), Lt.-Col. P . W. King (U.S.A.F. Hospital), Air-Marshal Sir Harold Whittingham, Captain J. M. Rymer-J£?nes (Assistant Commissioner of Metropolltan PolIce) and others. There were many he would like to thank f~r their part in making the event the success It had proved to be, but he felt that he must specially mention the judges.. who. are always so ready to give both skill and tune, the stewards, timekeepers, ' patients ' (me~ bers of the Guinness Amateur DramatIC Society) and Mr. A. Sainsbury Hicks (Headmaster of the Grammar ~chool). They were especially grateful to Ealmg and Pinewood Studios, who had so generously supplied the scenery, and to Mr. John Gow for so efficiently arranging the staging and effects, and who had recently been honoured by the Order of St. John of Jerusalem for special services. They must, also, congratulate Division.a} Officer Derek R . Fenton the CompetltlOn Secretary, who had be~n responsible for all the arrangements. Replying, Mr. Fenton wishe~ to emphasize the great help he had received from all his helpers. The results were announced: EALING CHALLENGE CUP 1. No. 85 (Ealing) Division 2. o. 134 Greenford

126 106

BARCLAY SMITH CUP 1 125 '2 L.T.E., Chiswick o. 64 ,Ealing Division 3. B.R., Euston

148 133 120

ARTHUR FENTON CUP 1. CN 15, Harrow 2. ]46 B.R., Camden 3. 44,IN, Acton ...

168 131 99

WILLOUGHBY GARNER CUP I. City of London PolIce 2. C78 Fai rbalrn House: .. 3. W. Division Met. PolIce

110

1l0~

103~

N. J. CALDWELL CUP 1. o. 85 (Ealing) Division 2. British Railways, Camden. FLORENCE CUP I. No. CN 15, Harrow. 2. British Railways, Camden. BROOKS CUP 1. G. Kirkham, 146 B.R. , Camden 2. R. Burgess, W. Division, Met. Police 3. B. Rowland, City of London Police BARNARD CUP I. D. Fulljames, CN 15, Harrow 2. W . Barrett, B.T.C. Police, London 3. A. Davies, B.T.C. Police, London HILL CUP I. E. McMillan, L.T.E. , Cricklewood ... .. . 2. F. Wade, L.T.E. , Cricklewood 3. C. Lower, CN 15, Harrow WRA~GHAM

73 71 90 83 82

89 81 78

CUP

T. Tyzack, C 78 , Fairba irn

House J. Ogilvie, B.R., Camden J. Buckley, B.R. , Camden

86 }

71 69 58

GO'''' CUP I. No. C 78 , Fairbairn House. 2. o. C 15, Harrow. WIDDOWSO;\f CUP 1. W. Hurst, No . C 78, F a irbairn House. 2. D. Pocock, o . C 34, Greenford and Northolt. Rising to present the trophies, Major White Knox said, . I am deJtghted to pay you this visit. In another eighteen months I shall have completed 50 years in the ambulance ~ef\ice, a nd I am proud of the fact that T took my first F irst Aid Certificate in 1907.' He went on to stress the value of competitions in raising the st a ndar~ of work, for they accu tom~d the com~etltors to working on inCidents 10 surround lOgS as nearly as possible resembling those of real cases, and they are also \alua ble in showing the members of the public the work they do. . K A vote of thanks to Major WhIte nox concluded a most ucces~ful event.

Research on Eye Diseases-Continlled future. The actual re.seal:ch is being sponsored and guided s~lentlfically by the Medical Research Councd , a.nd the resear~h team being sent to t~e Middle East WII! work in association WIth ~wo Vlru~ laboratories in London, at the Lister Institute and the Institute of Ophthalmology of London University, where it is hoped that, when the necessary progress has been made l?ca lly , the more complicated and speCIalized techniques will be pursued and elaborat~d. Such a scheme, of cours.e, depends for ILs efficiency and scope essentially on personnel but factually on finance: and althou~h sufficient has been obt~ined to .Iaunch It. its energetic pursuance LO attack 109 one of the greatest social p.ro~lems of t~e world will depend on contlOulOg UppOI t.

FIRST AID & NURSING, MARCH/APRIL 1956

Police Nt~tio"al First A.id Con,petitio" The 'Pim' pOLICE were everywhere-police in blue, police in green from Northern Ireland and police from Scotland with their distinctive draught-board cap band. Where? At the Porchester Halls, Bayswater. They were there to support their respective teams in their struggle for the coveted ' Pim ' trophy which would be presented to the first aid team which would prove to be the champion of the police forces of Great Britain and Northern lreland. The keenness of the competition was evident from the fact that only 21 marks separated the first two teams, and especially in view of the fact that the tests, one team and two dual practical, were by no means easy. In the team test the members are called to dea l with a workman who has fallen and been trapped by the legs under a heavy beam, whilst gas from a broken pipe is escaping near his face. He is found to be suffering from asphyxia (coal gas), a compound fracture of the lower third of both right tibia and fibula, with bone protruding and a simple fracture of lower third of left tibia. The test was set and judged by Dr. T. P . Howkins, of Eastleigh. The dual tests, both of which were set a nd judged by Dr. John T. Daly, of Quinton, were equally interesting. In the first Nos. I and 3 find a man lying by the kerb, having apparently been knocked down by a passing vehicle. His injuries are found to be contusion on right temple, fractured base, compression and wound on right leg with slight haemorrhage. Nos. 2 and 4 are called to a street brawl an d find a man who has been knocked down. He is conscious and is suffering from fracture of the 8th and 9th ribs on the right side, with possible injury to liver grazed wound on right hand and shock. ' At the presentation ceremony the chair was taken by Lt.-General Sir Otto Lund K.c.B., D .S.O. , Commissioner-in-Chief of the St. John Ambulance Brigade who opened the proceedings by stating that he was deputizing for Mr. Horace F. Parshall, T.D., M.A. (Oxon), the Director~General of the St. John Ambulance Association who was unavoidably absent. He had much pleasure in extending a cordial welcome to Mr. James Henderson M P Joint Parliamentary Secretary for S~otla~ci' who had. so kindly consented to present the trophies. There were many he said who had contributed to the succ~ss of th~ eve~t! and whom he would like to thank Jndl v l~ually, but this was impossible. The Assoclated British Picture Corporation Ltd., had again provided, erected and removed the scenery which had helped to ma.ke the tests so realistic. Those indefat igable gentlemen, the judges, they could t: ever thank too much. The stewards tI mekeepers and the competition secretary; M~. George Craft, who was always so reticent <)-bout putting his name on the programmes, .were all deserving of their thanks. SpeCial mention should be made of the ' patients' and make-up artists, all voluntary workers and St. John-trained and to~ay indispensable to the success of any major ~ompetition. Sir Otto referred to the subject of artificial respiration, in

which he is particularly interested but stressed the importance of restrai~t in applying it. The results were then announced as follows: 1.

Metropolitan Police, L Div-

ision ... 358 (winning the' Pim ' trophy) 2. West Riding Constabulary 'A' 3551(winning the 'Police Review' trophy) 3. City of London Police 341 t 4. GrimsbyBoroughPolice I Birmingham City Police ~ tied 334 No. 1 I 6. Exeter City Police ... 328i 7. Surrey Constabulary 'A' 314t 8. Swansea Borough Police 306i 9. Edinburgh City Police No.1 306t 10. Liverpool City Police 'A' 299 11. Royal Ulster Constabulary 2921 In presenting the trophies Mr. Henderson reminded his hearers that he was responsible for the police in Scotland, and he had always felt the importance of first aid in police work. He was most anxious to see first aid brought to the highest standard.

He congratulated both the winners and also those who had not quite made it. The comments of the judges are always most he!pful, and Dr. Howkins led the way. Expressmg the pleasure he had experienced in judging the competition he said that he had seen .some good first aid that day, but In refernng to artificial respiration he emphasized the damage which could be done by excessive pressure. There must also, be no delay in commencing. All had put up a good show. Dr. . Daly said that his colleague had made It very easy for him by saying some thing~ that he had intended to say. UnconscIOusness was a subject which requ ired considerable study, and some had shown some uncertainty about the position for this condition. He wondered if the recent supplement may possibly have created some doubt. Of the many who had shown their interest in the event by attending we noticed C~mmander G. ~ay~e, Capt. Rymer Jones, MISS Bather, Bngadler T. D. Daly, Major A. C. White Knox, Col. Young and others. A vote of thanks to Mr. Henderson concluded a most successful event.

Sussex County Competitions THE ST. JOHN AMBULANCE BRIGADE DESPITE the magnitude of the task undertaken by County Secretary Staff Officer C. Simpson, S.B.SU. and his colleagues Staff Officer W. L. Hancorn, S.B.SU. and Staff Officer D. H. F. Burchell in staging both Senior and Junior Ambulance and Nursing Competitions on the same day, the smoothness with which the events passed off reflect the greatest credit upon the efficiency of these officers. Some idea of the organization required may be gathered from the fact that no less than 16 competitions were running simultaneously. Only a brief outline of the tests can be given here, but they were all interesting. AMBULANCE TEAM TEST, set and judged by Dr. C. R. Oyler: The team is attending evening classes and finds the teacher lying on the floor. Injuries: stroke, incised wound to left forearm Colles' fracture of Jeft wrist and shock: A second casualty faints. ~ULANCE INDIVIDUAL TEST for No. ], Judged by Dr. H. Rosenberg, deputizing for Dr. E. M. Newman: He has to treat a man who has been rescued from a room in which was a coke fire Injuries: asphyxia (coke fumes) cut on head and strained calf muscle. ' AMBULANCE DUAL TEST for Nos. 2 and 3, set and judged by Dr. G. C. Gunderson: They have to attend a man suffering from apoplexy and a burst varicose vein. AMBULANCE INDIVIDUAL TEST for No 4 set and judged by Dr. A. SIess: ., A woman rushes out of a house and ~u~ons him to attend a casualty. TnJunes: severe wound of right wrist and shock.

He is called t.o a man who has fallen from a step-ladder. Injuries: fraclmed patella, slight cut on right hand and shock.

AMBULANCE CADET DUAL TEST for Nos. 2 and 3, set and judgcd by Mr. Hansford: A person is seen to be putting the milk bottles outside the door. He slips on the icy surface and the sound of breaking glass is heard. Injuries: multiple lacerations of the palm with glass embedded, fracture of lower end of forearm, severe shock complicated by pain.

3. 4. 5. 6.

AMRULANCE CADET INDIVIDUAL TEST for No.4, set and judged by Police Sergt. A. J. Griffin: He has to treat a boy who has crashed with his bicycle. rnjuries: closed fracture of right leg and shock.

NURSING INDIVIDUAL TEST for No. I, set and judged by Staff Officer Mrs. Johnston,

S.R.N.:

She has to fix a bronchitis kettle and construct a steam tent. NUR~TNG DUAL TEST for Nos. 2 and 3, set and Judged by Area Nursing Officer, Mrs. Tuck, S.R.N.: P.atient has a fractured right femur which is splmted. They have to attend to patient's back, change bottom sheet and make the bed.

NURSI!"G INDIVIDUAL TFST for No.4. set and Judged by Nursing Officer Miss Standley, S.R.N.: She has to change a surgical fomentation on elbow, take and chart T.P.R.

CADET SECTIONS AMBULANCE CADET TEAM TEST set and judged by Dr. R. Radford: ' The team, passing an isolated house hear a child calling for help. His fathe;' appears to have fallen from a chair on the table .. Injuries:. fracture of right · femur, !ace~atlOns of TIght forearm, faint. Child IS fTlghtened but otherwise unhurt. AMBULANCE CADET INDIVIDUAL TEST for No.1, set and judged by Police Sergt. W. Cowan;

Brighton Police ... (winning lhe Frederic Cadby Cup and the Dorothy Jarvis Cup) Worthing Eastbourne Horsham ... Hastings (Milton) ... (winning the St. John Council Cup)

284~

284 279 3 2781 253~

NURSING SECTION 1.

3. 4.

Brighton .. . ... ... (winning the Sir W. Gentle Cup and the Offord Cup) Worthing Horsham Eastbourne ... ... ... (winning the St. John Council Cup)

332i 3]9 316 289

CADET AMBULANCE SECTION NURSING CADET TEAM TEST, set and judged by Dr. D. Broomfield: . As for Ambulance Cadet Team Test.

1. 2.

NURSING CADET INDlVIDUAL TEST for No. 1, set and judged by Miss Brown , S.R.N.: Apply liniment to painful knee and bandage it. NURSING CADET DUAL TEST for Nos. 2 and 3, set and judged by Miss R. Martin, S .R.N.: They are required to re-make patient's bed, take and record T.P.R.

3. 4. 5. 6. 7.

NURSING CADET INDIVIDUAL TEST for No. 4, set and judged by Mrs. Rhodes , S.R.N.: She is required to apply a hot fomentation to patient's right shoulder. The presentation ceremony was presided over by County Superintendent Miss D . 1. Hubbard, M.B .E., D.SU. , deputizing in the unavoidable absence of the County Commissioner, and the proceedings opened with a very pleasing ceremony. Upon his retirement from the position of County Superintendent Mr. F. A. Trott. C.SU., was presented with a memento in recognition of his many years of service to the movement. In acknowledging this tribute, Mr. Trott said that, although he had retired from the position of County Superintendent, in which he had always tried to be absolutely fair to all parties, he was not leaving the movement . 'Whenever I'm wanted,' he said, '1 shall be there.' The audience rose and sang' For He's a Jolly Good Fellow.' Amongst the large audience present we noted The Lord Rupert Nevill; Major P. A . Uniacke, O.SU. (Deputy Commissioner); County Superintendent Mrs. E. M. Courtney, O.SU. ; County Nursing Officer Mrs. D . M. McPherson, S.R.N.; Mrs. F. A. Stuttaford, S.S. SU. (Area VicePresident, East Sussex); Capt. W. J. Hutchinson, C.B.E. , O.SU . (Chief Constable of Brighton); Chief Officer E. Calvert, S.B.SU. (Brighton Fire Brigade); and Miss K . Ward, S.R.N., M.C.S.P .. (County Director, B.R.C.S .). Staff Officer Hancorn then announced the results as follows :

AMBULANCE SECTION 1.

Southwick ... 290 (winning the Sir W. Gentle Cup)

Lancing ... .. . . .. (winning the Hinkley Cup, the Rothes Cup, the Trotter Cup) Worthing ... . .. (winning the Jarvis Cup) Hangleton Southwick Hastings Town Horsham Hurstpierpo int

305 270 266{ 257-i 250~

208!

1921-

CADET NURSING SECTION 1. 2.

NURSING TEAM TEST, set and judged by Dr. McAleenan: A boy calJs the team to his father, who has fallen from a step-ladder. His leg is en~an.gled in the rungs of the ladder. InJur.les: severe wound of right calf, with arterIal haemorrhage and glass embedded fr~cture of. left fibula, fracture of uppe; third of fight humerus, slight lacerated wound of left palm, faint and shock.

FIRST AID & NURSING, MARCH/APRIL 1956

3. 4. 5. 6. 7.

Hangleton 'A' ... ... ... (winning the Ilessborough Cup) Chichester (winning the Scott Cup, the Trott Cup and the Sussex Cup) Rye ... ... (winning the Bessborough Cup) Hangleton 'B' Horsham Southwick Brighton

255 251

223 223 ] 9R 196 177

CADET EFFICIENCY COMPETITION for the year 1955 Ambulance Cadets: Horsham (winning the Bessborough Cup. Nursing Cadets : Southwick (winning the Hailsham Cup). The National Award (The Grosve nor Cup) was also presented to Hangleton Nursing Cadet Di visi on for the highest number of books collected for the Hospital Library Service. The Cup has now been won outright by Sussex, having secured it for the past 3 yea rs. Well done, Sussex!

Unsatisfactory diagnosis Dr. Rosenberg was the first judge to comment, but explained that he had been asked to step into the breach occas ioned by the unavoida ble absence of Dr. Newman. He had, also, been asked to convey Dr. Oyler's comments as that gentleman had been called away to an emergency case before he could offer hi ~ own comments. Dr. Rosenberg stated that only one or two had conducted their diagnosis satisfaclorily. and laid particular stress upon the importance of comparing both sides of the body. 'Don't ask unnecessary questions,' he emphasized. With regard t.o his own test, only one had given a really satisfactory demonstration of artificial respiration by the Holger-Nielsen method. Artificial respiration badly needs brushing up .

Dr. ~roomfield said that many of the competitors only muddled through. and in some .cases the wound on t he forearm was not discovered until late in the test. She drew attention to the careless handling of , sterile' dressings. In more than one case ~ , sterile' dressing was only just saved in time from coming into contact with the ground. . Dr. McAleenan commented upon the h~g~. standard attained by the nursing diVISions. Tn most cases all iniuries had been diagnosed within 12 minutes. Four of t~e teams were worthy of special mentIOn. Dr. R adford was pleased with the treatment of the fractured femur in most cases but one or two spoilt it by raising the limb as part of the treatment of shock forgetting the fracture. One team, to ~hom he had awarded full marks for correct treatment, marred their work by rough handling. He reminded them that haemorrhage was one of those conditions in which they must be persistent. Tn no case had all the rules been carried out. Of pulse-taking, he said that it was of no use talking about it. 'You must be able to do it.' On the whole he had found the standard good. Tn presenting the trophies to the successful competitors, Mrs. E. M. E. Stewart Roberts, County Cadet Vice-President, said that not only was she delighted to be there that day. but she had been deli2:hted with the excellent work she had seen.County Cadet Officer Miss E. M. Trill, O.St.J., thanked the' patients', stewards and all who had contributed to the success of the event, and especially those who had kindly permitted the use of the magnificent Fairlight Schools. Tn mentioning the work of Staff Officers Hancorn and Burchell , she reminded them of the honour which had been conferred upon Staff Officer Hancorn for rescuing a workman last year.

Royal Review On Saturday, 12th May, 1956, at 3 p.m. Her Majesty The Queen (Sovereign Head of the Order of St. John) will review 21,000 adult members and 1,000 cadets of the St. John Ambulance Brigade in Hyde Park. This is the first time that a reigning Sovereign has reviewed the St. John Ambulance Brigade since 1912, when King George V held a review at Windsor. The Queen will be accompanied by H.R.H . The Princess Margaret (Commandant-in-Chief, St. John Ambulance Brigade Cadets) and by the Duke of Gloucester (Grand Prior of the Order of St. John) and the Duchess of Gloucester. The Royal Party will arrive at 3 p.m., when the Queen will tour the lines of St. John Ambulance Brigade members in a Land-Rover. The Queen will then have va riou s St. John officials and overseas representatives presented to her an d will afterwards take the Salute at the M arch P ast. Represent atives of the St. John Ambulance Brigade Overseas. including a con tingent from Malta and representatives from Hong Kong, Singapore and other parts of the Commonwealth will also march past.

Anterior Poliomyelitis By W. James Wright, S.R.N., B.T.A.

ANTERIOR poliomyelitis is an a~ute infectious disease caused by a VIrus, and although commonly known as ' Infantile' Paralysis it also attacks adolescents and adults. The disease often occurs in epidemics in some countries but in this country isolated cases or small groups are more common. The virus is conveyed by droplet infection and it is also believed to enter the body through the digestive system by means of infected food or drink. ]n some cases there is no paralysis but where paralysis does occur the course of the disease, briefly, is as follows. Once the virus has entered the body and become active it attacks, in particular, groups of motor nerve cells situated in the anterior horns of the spinal cord setting up varying degrees of inflammation. According to the amount of inflammation present various muscles or groups of muscles may become affected, causing paralysis sometimes affecting one or more of the limbs. If the nerve cells are completely destroyed permanent paralysis of the affected pa rts will follow, but usually a number of the iniured cells recover and a certain amount of improvement takes place. Simply, the paralysis occurs because voluntary impulses from the brain can no longer be passed on through the damaged anterior horn cells to the motor nerves. Symptoms of the disease The onset is sudden and is marked by fever, headache and restlessness being very prominent. Pain in the limbs or back is a common symptom and is often severe. Sometimes diarrhoea and vomiting occurs. Stiffness of the neck is another common symptom. Paralysis may occur according to the severity and extent of the disease. If paralysis does occur it will be of the flaccid type, that is, an affected limb, if raised and then let go, will fall limply to the bed. The paralysis is often more marked at the onset of the disease, later decreasing slightly or even disappearing entirely. In some cases the bladder may become involved causing the patient to either lose control of the bladder or preventing him passing urine. Occasionally the virus may involve the brain or its coverings (meninges). As soon as the fever subsides some recovery begins to take place but in severe cases it may take several months before a complete recovery is made. Some muscle groups are likely however to remain permanently paralysed and in these cases the muscles often waste, and, in the case of growing children the neighbouring bones fail to develop normally. The affected limb therefore remains smaller than normal, and, owing to the pull of the unaffected muscles, deformities may occur at the joints. Diagnosing Anterior Poliomyelitis On admission to the ward the patient is examined by a doctor who specializes in this type of disease, particular attention being paid to the reflexes and any suspected weakness of the muscles. Any congestion or soreness of the throat is also noted. Co~firmation. ho:vever, is made by pathological examlllatlOn of specimens of the cerebro-spinal fluid, these being obtained, usually under a local anaesthetic, by

FIRST AID & NURSING, MARCH/APRIL ]956 inserting a long hollow needle into the lumbar-spine, below the end of the spinal cord and allowing some of the cerebrospinal fluid to drain through the needle into sterile containers, about half a fluid ounce being sufficient. Treatment of Anterior Poliomyelitis During the acute stages the patient is confined to bed. This is for at least two weeks. ]f the limbs are affected they must be supported comfortably and padded splints must be applied to prevent deformities occurring. Care must be taken to see that the paralysed muscles do not become over-stretched. Aspirin tablets may be given for the relief of pain. Paralysed parts of the body have poor circulation so they must be well covered to keep them warm. If hot water bottles are used they must be well covered to prevent burning the patient. Special care must be paid to pressure areas to prevent bed-sores which easily occur if the pressure areas are neglected. In the case of paralysed arms the patient will of course have to be fed and his toilet performed for him. If the patient cannot swallow it may be necessary to pass a rubber tube into the stomach (through the mouth or nose), nutritious fluids being passed through. Continuous suction of the air passages may have to be carried out if swallowing is affected, to prevent the patient choking through the collection of sputum, etc. Where the diaphragm or other respiratory muscles are affected the patient has to be nursed continuously in a special respirator, commonly known as the' iron-lung,' and a patient can be nursed indefinitely in this apparatus: As soon as the acute symptoms have subsided and the patient is fit enough he is allowed out of bed in stages. In cases where there has been paralysis, massage and exercises are commenced as soon as the patient's condition permits but of course it will be longer before he is allowed out of bed. The 'Iron-lung' This is a metal tank approximately six feet in length and two feet square at the head, slightly tapering towards the foot. It is placed 00 a mobile frame. The patient is laid on the mattress inside the apparatus, his head protruding at the end and resting on a special head-rest. A soft rubber collar fits around his neck to help keep the iron-lung airtight. There are portholes on both sides of the tank through which the patient receives attention. These portholes are covered by airtight doors. When the doors are open the holes are protected by rub her diaphragms, each ha.ving a tiny hole in its centre, through which the hand and arm can be forced. The main thing is to prevent pressure escaping from inside the' lung '. An electric motor works the bellows which causes the air pressure within the chamber to alternate between normal atmospheric pressure and a slightly negative pressure. When the pressure within the chamber is negative the patient's chest expands and air is taken into the lungs and when the pressure returns to normal the chest contracts and air is forced out of the lungs. The depth of respiration is controlled by a pressure gauge and the rate of artificial respiration can be adjusted by the speed of the pump.

FIRST AID & NURSING, MARCH 'APRIL 1956

From a seat in the audience POLICE NATIONAL 'Where is the pain?' 'Here' would have been less suggestive of diagnosis than , ribs.' Diagnosis, which would have revealed fractured ribs, should have been completed before turning. It is noteworthy that police teams a lways show greater interest in the criminal than other teams. Few of the rib bandages were tight enough to afford the necessary support. Many teams still allow questions to take the place of physical examination. Was the plank of greater importance than the heavy beam? No team thought to lever the beam. Bricks and a plank were available. One team interrupted Silvester, then changed to H-N. There was often too much unnecessary 'phoning. We did not like the way those hot water bottles were slapped on to his tummy. Poor devil! The way he was moved about with fractured ribs! 'Is there blood from ears, nose or mouth?' Why not find out? How many experienced medical men could conduct a complete and thorough examination with the speed of some firstaiders? Policemen always search the victim's pockets! Was that trestle really in the way? Remember, Silvester is not yet obsolete. Some appeared to have forgotten it. Those cups and saucers left on the ground again! A.R.- When shall we see correct timing? Were all those detailed instructions to an experienced ambulance driver necessary? Experienced teams know that the doctor will be out on his rounds and will not be avai lable before the end of the test. Instruction to bystander sent to 'phone: , Come back and let me know the answer.' What abnormal positions were occupied by the 8th and 9th ribs in some patients! Regional anatomy needs attention. Those' sterile' dressings on the ground! One team wasted 3 minutes before commencing A.R. Turning off the gas won't clear the atmosphere immediately. lnterrupted A .R. to listen to breathing. Hot and cold water to face alternately. Where did the hot water come from? On one occasion we saw the hot water bottles produced before they had been asked for. Elevate the limb. How often this is forgotten. , Can you breathe? Well, don't.' The beam (which was supposed to require five men to carry it) started with five and finished with two. Efficiency is becoming more and more sacrificed to speed. Because a limb is splinted it must not be handled with less care. Two bystanders doing nothing. Why not help lift? Always support the head for drinking. Continued on page] 2

The Repair

Squad When you receive a wound or a burn, your body mobilizes its repair squad to make good the damage. Infection by bacteria hinders the repair squad in its work and may even overwhelm it, so that the wound heals slowly or not at all.

infection must be prevented or suppressed, and this some of the older antiseptics do quite effectively. But no antiseptic, however efficient, will heal a wound; only the repair squad can do that. The drawback of the older antiseptics, such as acriflavine, tincture of iodine, propamidine, etc., is that they interfere with the repair squad's activities -

and thus themselves slow down the process of

healing. , Furacin " however, is an entirely new type of germiCide, which destroys bacteria and prevents infection outstandingly well, and yet leaves the repair squad unharmed to get on with healing the wound. For this reason, 'Furacin' is becoming more and more Widely used in hospitals and first-aid rooms in this country and America. Made up as an ointment, it is easy to handle, and stable, and is available in a range of pack sizes to suit all users.

FURACIN *SOLUBLE OINTMENT t he pot ent antibacterial especially designed fo r wo unds and burns ,

Available in 1-oz. tubes, 4-oz. and 16-oz. jars Further details on request

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FIRST AID & NURSING, MARCH/APRIL 19S6

From a seat in the audience Continued

FIRST AlO & NURSiNG , MARCH/APRIL 1956

* First-Aider'Js Crosslf)ord No. 22

COSTIVE

CHARACTER

Remember Edith?

Compiled by W. A. Potter

Sussex S.J.A.B. Now, Captain, make up your mind. Which is it, equal parts, I in 3 or 3 to I for cold compress? One cold compress was changed after 80 seconds. Too much delay in applyi ng direct digital pressure. 'Tear that packet open for me ' (to a layman). No warning as to possible contamination by fingers. Don't give messages to laymen which are too long or complicated. A blanket is unnecessary if not used. Tn using an upturned chair on a stretcher, ascertain whether it will be placed in an upper or lower berth . This is a frequent oversight. Now, Inspector, a little less drama, p lease. The age of the patient is asked more frequent ly today. The poor devil was nearly stripped, but no-one thought to cover him. Was it necessary for three bearers to attend a faint? The technique of turning the patient was generally good by the women. Cadets should be taught to talk to the patient. Did not the attempt to stage the Senior and Cadets' Competitions on the same day place a rather heavy strain on the organizers? Assisting patient into bed. Tn many cases this was merely a gesture. Bedmaking was again excellent by the juniors. Test for breathing- we thought she was going to kiss him!

Eali ng Open Could not one bearer have disposed of the female patient? No-one was posted to control the traffic. Too much manipulation of the ank le by some competitors. The female patient should not have been left unattended (vide text-book). Why telephone when she only lived just round the corner? 'Did you hear a snap?' Too much reliance is placed upon this. Ingenuity- a shoe used to carry water from the stream. Why were the classic sig ns (clavicle) not used? Several forgot to loosen the braces. Those shoulders must be pulled back, even at the expense of some pain to the patient. Stick your knee into his back. 'Don't worry'-even before she had entered the door! Don't put leading questions to the patient. Those dressings on the muddy ground must have been filthy. Bystander: ' i 've got some hot-water bottles.' He should have waited until they had been asked for. Telephone message: ' There's been an accident here.'- Where? , How many more minutes have we got to go? ' Support head AND sho ulders.

• .. she's still as edentulous as ever, for her lower alveoli have absorbed to the point where nothing will seat. So she avoids like the plague any roughage foods, no matter how good they may be for her bowels. But both she and her constipation are seen in the surgery far less often, for now she takes a small daily dose of PETROLAGAR Plain (blue label). P ETROLAGAR is composed of 25 % mineral oil emulsified with certain bulk and madefaction-retaining substances. Mixing intimately with the intestinal contents, it helps to make up the deficiency in moisture and mass, restoring a natural consistency Petrolagar Emllision is provided ill two varieties to meet individllal to the fteces. needs. Plain, lor the average case

of simple and spastic constipation

PET R OLAGAR

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ACROSS 1. The acme of deafness (8) S. That which mitigates pain a nd suffering (6) 10. Medical arrangement ... (7) II. He strokes his patien ts (7) 12. Vomit five out ... (4) 13. Bone of the ear (S) IS. Add a drop (3) 18. Children (including little Susan) (5) 19. Ammonia or lime for example (6) 21. How tea m ay be consumed (3) 22. Mentally deranged (6) 24. Bone of the nose (S) 27. Time of winter accidents (3) 28. A hitch in treatment ... (S) 31. Its dresser will cut it painlessly (4) 34. Proverbially brings no good ... (3,4) 3S. Nerve of 102 cats (7) 36. Stretch out nurse at last (6) 37. The last pain? ... (8)

MEN~S

UNIFORMS and LADIES~ GREAT ~OATS & ~OSTUMES

DOWN 1. Most of us have ou r own (6) 2. Orga n s form via sore (7) 3. The heart is a double one (4) 4. Nea ds a chair (S) 6. Freedom from pa in (4) 7. Sluggishness (7) 8. As if dirt would do here! (S,3) 9. African warriors look like a devil (4) and me 14. Giddiness when' go aft~r gre~~ (7) 16. A tap on this boneis not amusing! (S) 17. ] ntra -vascu lar fluid (S) 20. Rescue apparatus in h a nd (8) 23. Colourful Fever (7) 2S. Good for a stretch (7) 26. L07enge (6) 29 . Bird, day or ship (4) 30. A .T.S. a nd four come back for a view (S) ... . .. 32. M ay follow the gang in orthopaedics (4) 33. Mammalian secretion ... (4)

for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

HOBSON & SONS (London) UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS S.E.1 LONDON BRIDGE 154 -164 TOOLEY STREET

SOLUTION TO CROSSWORD No. 21 ACROSS 4, Peas; 8, Thumbs; 9, Mirage ; 11 Systemic; 13, Dining ; 14, Tug; IS , Scorer ; 17, Exhale; 19, Scalp-Laceration' 21 Visual' 23, ~atest; 26, Era; 27, Retin~ ; Neo~ mycln ; 30, Attire; 31 , M a llet ; 32, Rate.

28,

DOWN I, Stasis ; 2, Nurses; 3, Able; 5, Electric Blanket; 6, Smudge ; 7, Bronchitis ; 10, Gar:glion ; 12, Moral; 16, Cellulitis; 18 , ACCident; 20, Ratio ; 22, Leader ; 24, Tickle; 2S, Tnnate ; 29, Moat.

ROAD, N.\V.I

'Phone:

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'Grams:

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FIRST AID & NURSI G, MARCH /APRIL 1956

Beaders-J Queries Answered by Dr. A. D. Belilios R. T. (Workington) writes:Will you please settle a doubt in respect to Holger-Nielsen Art. Resp. Supplement states on pages 6 and 7: expiration 2t secs., pressure 1-2-3, inspiration 2t secs., lift 1-2-3. There is a slight interval for the change from movement 1 to 2. At the foot of page 7 it states:-Whei1 patient shows signs ofbreathing, etc., raise and lower arms 2t secs. up, 2t dOlvn. This gives a rate of 12 times to the minute. The query is holV many times to the minute does the shoulder blade pressure and arm uplift give? The Civil Defence Manual gives 9 times to the minute and so does The L(fe Saving Society, our Doctor says ] 2. HolV many do you say? Answer

According to the Danish Red Cross who have published a lot of literature and developed the Ho1gerNielsen method, the rate should be 9 times to the minute until the patient shows signs of recovering when the arm raising technique only should be continued at the rate of 12 full respirations per minute. J. C. C. (Isle of Man) writes;At a recent competition practice theIol/owing team test IVas set lvhich caused a lot of controversy with the general opinion of the team against that of the' judge' who was in fact the team's trainer. A casualty is brought by police into a racecourse first aid station having been beaten up by a racecourse gang. He is conscious but has the following injuries, simple fracture oj left side lower jaw, and a very severe incised wound of left wrist with profuse bleeding, also severed lvrist tendons. It was in the matter oj transport on the stretcher that the team disagreed with the ruling, which was that the patient should be placed in the ! prone position (right side) for the following reasons. (1) Patient very weak from loss of blood and shock.

(2) Possibility of patient becoming unconscious. (3) Excess flow of saliva. (4) Patient ma), vomit during transport to hospital. (5) Partial loss of control of tongue due to jalv .(racture and general weakness of patient. (6) The application of barrel bandage whilst being necessary to support the ./(lIV would retard the rapid clearance of the mouth in the event of sudden vomiting with danger of ' Inhalation Pneumonia ' or asp/iJ 'xia. The team however, did not agree and gave as their reasons: (I) PaNent was net unconscious. (2) Fracture of jaw was one side only. (3) There Il'aS 110 bleeding from gums or (nouth. They did not in fact see any risk in transporting on the stretcher il1 the supine position. We lVould very l11uch appreciate the views of Dr. Be/ilios particularr)' in view of the 17eltl supplement No.3 to the St. John Ambt.k,·nce Association textbook wherein great stress is laid 011 the danger of inhalation pneumonia. Answer

The patient is not unconscious hence in my opinion, the general rules for the treatment of asphyxia do not apply and I hope that the standard of your first aid would prevent unconsciouwess occuring. There does not seem to be any reason why the normal prone position for transport should not be adopted. The affected wrist, after it has been treated, being secured to the stretcher handle by a narrow bandage if necessary. F. R. (Castlegar, B.C., Canada) writes :-. A recent instructor told us that fo!' the Holger-Nielsen AI tiftcial Respiration, the count should be twelve times pel' minute, not nine limes as outlined in St. John 40th Edition. Would appreciate y our opinion. Answer

Greetings to our Canadian readers. The answer to your query is covered by R.T. above. J. S. E. (Exeter) writes:I have had a letter ji-om a cousin in Australia. He tells me that he is

suffering badly from Migraine. OpiniOl1s seem to differ about this complaill t. I should be gratefulfor a few 11'0rdsfrom Dr. Belilios on the subject.

FIRST AID & NURSI G, MARCH APRIL 1956

STRETCHERS

Qualify Nurse

are only one of the hundreds of items of

Answer

This common ailment cons.ists essentially of recurring intense headaches often accompanied with nausea and vomiting. Numerous other symptoms may accompany, e.g. giddiness, mistiness of sight, seeing half of objects and prostration to such an extent that the patient may have to rest in bed in a darkened room. The cause is not reallv known but the complaint often run's in families. Some cases are nervous in origin.

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WANTED . Competition Tests on mine accidents, road accidents and individual tests. What have you? Box No. 757, • ['irst Aid and Nursing,' 32 Finsbury Square, E.C.2. eries 8 and 9.

Five team test papers 5/-, eight individual test papers 5/-. Selby & Plowright, 135 Russell Street, Kettering. CLOWNE AMBULANCE COMPETITION. Saturday, June 30th, 1956. Competition, for the Christopher Wright Challenge Cup, open to all England. Prizes for winners and runners up. Individual competition entries on the day. Entry forms from the Secretary, Mrs. Lo vatt, 10 Clune Street, Clowne, Chesterfield, Derbyshire. Entry fee 10/-. SCENT CA RDS. 250 17 /6. 1.000 52/6. Tickets, Printed Pencils, Memos . Samples free.-TICES , II Oaklands Gro ve, London, W . 12. S.l.A.B. Car Badg;es, 30s. S.l.A.B. Badge Wall Shields, 26s. 6d. S.J.A.B. Gold cased crested Cuff Links, 50s. S.J.A.B. Badge Ladies' Brooches, 21s., Trophy Shields supplied. Medal ribbons 9d. each on buckram for sewing on uniforms. Is. each ribbon if mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for leaflets.- Montague Jeffery, Outfi lter, St. Giles Street, Northampton.

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WANTED. The St. lohn Text- Book in which is recorded trained Brigade Units rendering perfect First Aid, where unorganized Ambulance pupils failed. £1 offered. Box No. 758, 'First Aid and Nursing,' 32 Finsbury Square, E.C.2.

IN THE ARMY **

service to

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AS A

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FIRST ALD Competition Papers.

for HIGH BLOOD PRESSURE

* * Here's your chance to train to be a nurse in the happy

To sufferers from this complaint and asscciated disorders comes welcome news of an inexpensive everyday remedy, hitherto only available in costly capsule form. RUTIN-'T is made from the dried leaf and flower of Buck Wheat, which is the source of precious Rutin, and is at last readily and cheaply obtainable. Developed in the U.S.A. during the war, it was found to strengthen the blood vessels and was used to counteract internal haemorrhage caused by contact with atomic radiation. RUTIN-'T' ut ilises the natural properties of the plant, for both prevention and treatment of hypertension (High 8100d Pressure) and it reta ins other beneficial substances including Chlorophyll, which are refined out of pharmaceutical Rutin. RUTIN -'T' acts as a preventive, delays the effects of advancing years and is a health-promoting tonic. PRICES RUTIN-·r in cartons for 1 month's supply

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FIRST AID & NURS1NG, MARCH /APRlL 1956

FIRST AID & NURSING, MARCH/APRIL 1956

BAILLIERE BOOKS FOR FIRST AlDERS A HANDBOOK OF

BAILLIERE'S

FIRST AID AND

Arthur D. Belilios, M.B., B.S., D.P.H., and Dorotbea Duncan-Johnstone, S.R.N.

First aid books a, a rule confine themselves to injuries e.g. fractures , wounds, burns, scalds, etc., This volume is far wide: in scope. .It covers medical conditions of all kinds, and much of the Il1form a tl~n IS not. to be found easily elsewhere. There are chapte rs on: case-taklOg, medl~al causes of unconsciousness, internal haemorrha'ge, first aid in maternity cases first aid in spinal injuries, asphyxia, industrial poisoning, the use of n~orphine. 'Undoubtedly the best of its kind.' Nursing Mirror. Fourth Edition. With 488 pages and 200 drawings. 8s. 6d.

With 314 pages and 57 drawings 8/6

for the

HANDBOOK OF

ELEMENTARY NURSING This handboo k is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. ~t describes in simple language the bas~c principles and procedures that unde~he the science of nurslO g, a nd contains brief descriptions of the more common diseases, with general notes on the nursing required in each case. A. complete chapter is devoted to the subject of home nursing, and the whole book P,rovides fo r every first aider the essentIals of nursing in handy yet comprehensive form .

GARROULD'S

BANDAGING

Regulation Unifornt

by Arthur D. Belilios, M.B., D.P.H., D. K. Mulvany, M.S., M.B ., F.R.C.S., F.R .C.P., and Katharine F. Arm)trong, S.R.N., S.C. M.

Bailli~re, Tindall and Cox

7-8 Henrietta Street

for

OFFICERS

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Ir,::::====================- Established over 100 years ====================:ril We have specialised in the making of Nurses' Uniforms for nearly 100 years and have a reputation for good quality materials and superb workmanship.

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.... ............ copy/ ies of A Handbook of Elementary Nursing Please send me { ................ copy/ies of First Aid and Bandaging

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for which I enclose remittance oL ........ .. ........... (Postage 9d. extra per volume.)

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WORK

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ROAD,

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PATENT

"PORT AND" AMBULANCE GEAR The Gear ilIustrated(A.B.C. D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

Designed to nest in transit veh ide or when stored . Rubber stops locate stretcher and provide handles. INVALUABLE IN COMPETITION

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The UP AND DOWN act40n is quick and easy for loading or unloading. A. Shows the two stretchers in position.

THE HOUSE FOR

HUMAN

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SKELETONS

Articulated and Disarticulated HALF SI{ELETONS, Etc., Etc.

C. Illustrates the same Gear with the top stretcher fra me hinged down for use when only one stretcher case is carried. D. Shows the same position as in .. C ' only with cushions and back rest fitted for convalescent cases.

Where Ambulances are reqUired

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Human Osteology, Anatomy, Etc.

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IRST AID &: NURSING MAY/JUNE .1956

This vehicle is a 4-wheel drive Land Rover which has been modified and equipped as a mobile dispensary. Features include insulated roof. special ventilation, builti'l \M?"hing facilities. fresh water supply from Polythene tank, fitted cupboards for drugs. dressing and splints. The nearside body interior is fitted With a folding stretcher gear, and additional accommodation is provided by a tent which fastens on the rear of the body when the doors are open. and the dispensary is in operation. You 2.re invited to apply for full details of Mobile Medical Units, Ambulances, etc., built to your particular requirements for service in any part of the world.

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bactericidal thus obviating the need, when not convenient, of changing the dressings every day. fOR CUTS, ABRASIONS, BOILS and numerous skin infections, ANTIPEOL is unquestionably the remedy. It is already in widespread use by the medical and nursing professions in many parts of the world. ANTIPEOL is therefore an essential component of eyery First Aid and Nursing Kit.

Printed by HOWARD, ] ONES, R0BERTS & LEETE. Ltd., 26-28 Bury Street. St. Mary Axe, London, E.C.3, and published by the Proprietors, DALE, REYNOLDS & Co., Ltd., at 32 Finsbury Square, London, E.C.2, to whom all communications should be addressed.

FIRST AID & NURSING, MAY/JUNE 1956

Bedford The 'one-make' fleet

Lomas ' 8 type" ambulance 00 Bedrord A2 ambulance

chassis. Prices from . . . £1 ,504.2 . 6.

First Aid &

Nursing Editor: Peter I. Craddock This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E. C.2, for the purpose of providing an informative technical service on first aid and nursing. We welcome contributions.

May/June 1956

In this Issue

It pays to standardise on

Bedford Day in, day out Bedfords brilliantly perform all the varied transport tasks of public authorities. No other range of vehicles has such a high reputation for reliability and economy. Modernly designed Bedfords form the ideal 'one-make' fleet; they pay in every way! 'Onemake' transport means greatly simplified maintenance and spare part stocking. To this add the extra Bedford advantages oflow first cost,

low upkeep cost, low-priced readily available replacements, and Square Deal Service from 520 authorised Bedford dealers. With a range of chassis covering all loads from 10 cwt. to 10 tons, there is a Bedford for every local government needyou see them everywhere. Full particulars from your local Bedford dealer, orwri te direct to the M unici pal Vehicle Department, Vauxhall Motors Limited, Luton, Beds.

FOR EYERY LOCAL GOYERNMENT NEED

40 Seater Buses from n,740

Florence Nightingale House. . .

Eyes

How Shall We Teach First Aid and Nursing?

Competitions ...

From a Seat in the Audience

Skeletons for Teaching Purposes 10 Refuse Wagons from £595

Readers' Queries

First-aider's Crossword

Cesspit Emptiors from £ 1.331

Bedford Scammell Tractors from £713 plus £152.1.4 P.T

n o you know that . .. In women there al'e five more heart-beats to the minute than in men?

Vans from £420 plus £74 . 18.9 P.T .

The prostate gland begins to enlarge in 45 % of men over 40 ? In Japan solid food, pre-masticated by the mother, is fed to babies at a very early age?

Crew Bu ses from £519 . 10.0

Ozone is artificially introduced into the air pumped through the stations on the London Underground?

In 1944 an alarming outbreak of typhus occurred around Naples and was arrested in three weeks by dusting 1,300,000 persons with D.D. T. (dichloro-diphenyl-trichloroet hane) at the rate of 73,000 per day? Tower Wagons from £1,195

Normal sight can distinguish about 150 different hues in the spectrum ?

Flor ence Nightingale House I T was a neat, unpretentious card which informed us that Lord Luke (the Rt. Hon. Lord Luke, T.D., D.L., is Chairman of the Florence Nightingale Memorial Committee) requested the pleasure of our company at Florence Nightingale House to meet nurses from all parts of tb e world. There were 46 nurses in residence at the time, and many of them were wearing their national dress at tbe At Home, presenting a colourful scene which would be most difficult to describe. They were in London for the purpose of taking advanced post-graduate courses, including Health Visitors', Nurse Administrators', Nurse Teachers' and Industrial Nurses' courses at the Royal College of Nursing and other teaching centres, and 'Florence Nightingale House would be their home for the duration of their stay in England. There was the matron of a hospital in Northern India, in her bright yellow flowing robe, who told us she was studying English hospital administration. It was interesting to learn that, despite the handicap of less modern equipment with which she was at present provided, the standard of her nurses was very high. The nurse from Singapore, who volunteered to act as our guide, and who introduced us to several of ber colleagues, described the seven separate hospitals in Singapore, each specializing in its own sphere. She told us that she herself intended training as a health visitor, in which capacity she felt that she could do much useful work. Many of those to whom we spoke were, undoubtedly, idealists. There was the dainty little nurse from Japan in her picturesque kimono, nurses from Thailand, Nigeria, Greece, Cyprus, Korea, Hong Kong, East Africa, Burma, Penang, Malacca, most of whom were wearing their own national dress. We had a long chat with the High Commissioner for Nigeria, and were particularly impressed with the enthusiasm with which he spoke of his plans for the progress of his country. He recalled with pride his role when Her Majesty the Queen and the Duke of Edinburgh toured his country recently, for he was in attendance upon her throughout her tour. Florence Nightingale House was acquired and equipped in 1948 for

the benefit of nurses by the generosity of the Joint Committee of the Order of st. John and the British Red Cross Society, and has been entrusted to the National Memorial Committee for maintenance and administration. In addition a grant was made by the Joint Committee to secure maintenance of the House until funds could be raised independently for this purpose. The success of its administration is due largely to the efforts of its indefatigable honorary secretary, Miss M. E. Craven, R.R.C., who is Matron-in-Chief of the British Red Cross Society, and whose office is at the B.R.C.S. Headquarters in Grosvenor Crescent. Nor must the part played by the Warden, Mrs. Lavender, be overlooked, for her charming personality and anxiety for the welfare of the guests play a most important part in the success of the Home. The distinguished guests present at the At Home included Mr. M. T. Mbu, Commissioner for the Federation of Nigeria, and Mrs. Mbu; Alhaji Abdulmaliki, Commissioner for the Northern Region of Nigeria; Chief M. E. R. Okorodudu, Commissioner for the Western Region of Nigeria, and Mrs. Okorodudu; Che Wan Baharuddin and Mr. D. K. Daniels, representing Malaya; Mr. D. W. F. Mayer, Student Liaison Officer, Cyprus Office ; Mr. T. O. C. Okiako, Commissioner for Eastern Nigeria, and Mrs. Okiako; Mr. G. H. Gordon, Trade Commissioner for the British West Indies, British Guiana and British Honduras, and Mrs. Gordon; Lady White, wife of the High Commissioner for Australia; Sir Gerald Whiteley, representing Borneo, and Lady Whiteley; Monsieur Tuomioja, Finnish Ambassador, and Madame Tuomioja; and the Hon. Myo Mook Lee, envoy Extraordinary and Minister Plenipotentiary, Korea, and Mrs. Lee. We also noted Her Grace, the Duchess of Marlborough, C.B.E., J.P., who is Vice-Chairman of the Committee, the Countess of Limerick, G.B.E. , L.L.D., who is also a Vice-Chairman of the British Red Cross Society, Viscountess Wimborne, Mrs. O. S. Prent.ice, C.B.E., and other members of the Committee. The grand work of the Florence Nightingale Memorial Committee should be far more widely known.

FIRST AID & NURSING, MAY/JUNE 1956

A Course in Elementary First Aid

Eyes By A. David Belilios M.B.) B.S. (Lond.), D.P.R. (Eng.)

one can be engaged in the N o active practice of first aid for very long without running into ~he eye patient who may be sufferIng from a foreign body in the eye, an internal injury of the organ or an actual disease which he has not reco gnized. . Considerable care and skill on the part of the first-aider is essential when dealing with this type of case and usually the patient will have to be referred to a doctor. Nevertheless the ailments described in this article are so common that the firstaider must be 'au fait' with a method of examiillng the organ and dealing with simple ailments. Many of the complaints that we have already described in these articles such as unconsciousness, fractures, severe bleeding, etc., though most important in themselves, are not common in actual practice. The eye case, however, is frequently met and the public are apt to judge the efficiency of the whole movement of first aid on the way in which the first-aider tackles a problem of this kind. The man in the street-who knows no first aidis not able to judge the efficiency of the treatment of the more serious conditions but he does expect service if he gets a minor ailment as it were, for example, a foreign body in his eye. Foreign Bodies Insects, pieces of grit, sand, metal, etc., often enter the eye and may be quite difficult to discover.

The symptoms and signs are of course well known. They include a sensation of grittiness while the eye becomes red and inflamed, profusely discharging tears. The onset is sudden commencing of course when the foreign body enters the eye. A thorough examination must be undertaken to discover the situation of the foreign body and remove it. In the first place it is desirable to have handy a twirled up piece of cotton wool that has been previously dampened with cold water and has been placed on a clean surface near the patient. The patient himself must be arranged in a comfortable position. This should be preferably sitting in a chair with his head thrown slightly backwards. The first-aider should stand behind him letting his head rest on the back of the chair or on the front of his own body. The first place to examine is under the lower eye-lid. The patient should be instructed to gaze upwards and the first-aide"', using his thumb, should gently 7'..:11 the lower lid away from the eye ball practically turning it inside out so that the whole of its red surface is exposed. A quick examination wjU disclose the foreign body as a bJack speck adherent to the inner lining of the lid. If the foreign body is not under the lower lid, the pro babih ty is that it is hidden under the upper lid , which must therefore also be everted, i.e. turned inside out. This process

is, in fact, very simple although it sounds unpleasant. Nevertheless it requires skill a nd every student should practice everting the upper lid during first aid classes until he is efficient in the process. - Eversion of the lid is quite painless and the patient should be reassured that the examination will not cause him pain because if he flinches or resists, the procedure is . naturally much more difficult. The patient is instructed to gaze downwards towards his tie and to relax as much as possible. With the forefinger and thumb of his right hand, the first-aider grasps the eyelashes of the upper lid and pulls them downwards towards the cheek. Using the forefinger of his left hand as a lever, he presses on the centre of the skin of the lid and gently presses it inwards. At the same time he pulls the upper eyelid upwards over his finger when it will become everted, and can be so kept by the finger of the left hand pressing the upper rim of the lid inwards. Once agai n a brief examination wm show the presence of the foreign body. If it is not discovered here, the foreign body may be even higher up towards the upper part of the orbit but in this event it is wiser to defer further examination and to refer the case to a doctor. Removal of a piece of grit, insect or whatever it may be is generally easy. It is only necessary to touch it with the point of the twirled up end of cotton wool or handkerchief to

PUPIL

Fro. 154.-Ex.u.mu.TION 01" LoWER LID.

}'w. lC.J.-EVERTING THE UPPER LID (FiRST STAGlI:). Fm. 156.-UpPER LID EVEr.TED WR EXAMIN~noN.

Illustrations from Bailliere's ' Handbook of First Aid and Bandaging.'

FIRST AID & NURSING, MAY 'JUNE 1956

which it will adhere. A few blinks possibly assisted by slight movement on the part of the first-aider will restore the upper eyelid to its normal situation and although the patient may be left with a sore eye his condition will rapidly improve. Quite frequently when a foreign body cannot be found under either of the eyelids, it will be discovered adherent to the cornea. A good light is essential in looking for a foreign body in this situation. The lower eyehd must be pulled downwards and the upper eyelid upwards so as to give a clear view of the whole of the front of the eye. If there is any suspicion of a foreign body on the cornea, first aid must be confined to putting a few drops of olive oil, castor oil or liquid paraffin in the eye and then covering the organ with a good pad of cotton wool which is secured in position with a narrow bandage taken round the head. No attempt whatever must be made to remove the foreign body since this is a delicate process even for a doctor and has to be carried out under a local anaesthetic, e.g. cocaine. Any attempt by someone who has not the experience or qualifications may result in serious injury to the organ and permanent impairment of sight. The object of the pad and bandage round the eyeball is, of course, to restrict movement of the organ. Corneal Abrasions Quite a number of patients have all the symptoms and signs of a fur6gnbody in the eye but none can be detected on examination. These symptoms and signs may well be due to a small scratch on the front of the cornea caused by a foreign body which may ha ve washed itself out of the eye. A corneal abrasion is very difficult to detect. The first-aider, during the examination may notice a slight loss of the normal translucency of some part of the front of the eye. But generally, unless he is very experienced, he will see nothing and even the doctor will be only able to discover the presence of this injury by a special test. A few drops of a brownish dye called fluorescine are placed in the organ which is then bathed with saline or ordinary water. If there is an injury to the cornea it will be shown by a small greenish stain on the front of the eye. It will be readily understood that this test is quite beyond the scope of first aid

hence the golden rule that whenever the patient complains of the symptoms and signs of a foreign body in the eye yet none can be discovered he must be referred to a doctor who may in turn refer him to an ophthalmologist or a hospital since the treatment of eye disorders is a very specialized subject. If a corneal abrasion is neglected, germs may set up inAammation and produce an ulcer resulting in a permanent scar and impairment of sight. Diseases of the Eye These again may come to the firstaider asking for advice and treatment. There are of course many such ailments for example, conjunctivitis - inflammation of the covering of the white of the eye and the eyelids, iritis-inflammation of the coloured curtain behind the cornea, and many others. Symptoms and signs may be very similar to those of a foreign body with the addition in iritis of actual pain. The first-aider must flatly refuse to have anything to do with cases of this kind and must refer them without delay to a doctor. He should withhold all treatment in the interval since giving any advice might cause the patient to procrastinate and in certain C'o1ditions, for example, iritis, the sooner treatment is begun the better it is for the patient. Blows on the Eye These are not uncommon in sport. For example, a tennis ball may be received on the organ even when the lids are closed. The injury may cause serious consequences within the eyeball, because the delicate structures may be damaged or the back of the eye, for example, the retina, injured. The accident may be very deceptive since after the initial shock the patient may complain of no symptoms yet later a defect of vision may result or if the cornea has been injured, inflammation may arise. It follows, therefore, that any patient who has suffered in this way should be ad vised to see a do-.::tor so that he can be kept under observation, and an examination of the inside of the eye can be conducted by the use of a special instrument called an ophthalmoscope. This instrument, familiar to all who have had their eyes examined, enables the doctor to exami ne the reti na to see if perchance it has been damaged.

Black Eyes These are due to slight haemorrhage under the skin of the lids, caused of course, by some form of a blow. The bleeding passes through the usual changes associated with a bruise producing a bla,:k eye. Sometimes there is also bleeding under the white of the eye, this bleeding is known as subconjunctival haemorrhage. The usual first aid for a black eye is to apply a cold compress and secure it in position with a pad and bandage, but the first aider must always be on his guard since it is possible that a more serious injury may be present, such as a fractured base of the skull as has already been described in the article on unconsciousness. Burns These are not uncommon in factories and laboratories where chemicals are Llsed and may be caused by splashes with acids or alkalis. The result can of course be serious. Apart from the immediate pain and inflammation, ulceration and scarring of the cornea may follow leading to permanent impairment of sight. There are seve ral alternative treatments. The first is to flood the eye with water, holding the lids apart while this is done. The water may be poured into the eye from a jug or other suitable vessel if at hand, for example, the glass undine designed specially for this purpose. As an alternative, the patient can be instructed to blink eyelids under water. Some authorities point out that when a strong acid such as oil of vitreol is mixed with water intense heat is produced and hence further burning occurs. They therefore recommend flooding the eye with olive oil, liquid paraffin or an antid<?te, e.g. 3 %bicarbonate of soda solution for an acid burn, and weak boracic lotion for' one caused by an alkali. But these treatments are not generally readily available when the accident occurs and in any case directly the corrosive enters the eye there is profuse flow of tears consisting mainly of water. Hence there is no object in delaying treatment while an oil or antidote is obtained. After first aid has been applied, the eye should be covered with a soft pad and bandage and medical assistance sought.

FIRST AID & NURSING, MAY/JUNE 1956

HOW SHALL WE TEACH FIRST AID AND NURSING t By F. C. Reeve, F.Z.S., F.R.E.S., F.I.C.A.P. yEAR after year efforts are made to bring the public to realize the importance of a knowledge of first aid and elementary nursing in everyday life, and the figures published annually by the great teaching organizations prove beyond doubt that this propaganda is bearing fruit. The numbers of students anxious to acquire this knowledge grow yearly, and classes are formed and lecturers appointed to meet the growing demand. So far, so good, but are the classes always one hundred per cent. successful 7 If not, where lies the defect? Can it possibly be due in some cases to the methods adopted by lecturers and demonstrators? Suppose we examine, first of all, the material upon which we hope to work. It will, I am sure, be agreed that a large proportion of our students are drawn from the great mass of people engaged in trade, commerce, industry or the professions- in short, those who, in various ways, are devoting a large proportion of their time to earning their daily bread. Many have left their schooldays far behind, and methods of teaching which may have been effective when the mind was both more receptive and retentive are hardly suitable for use in cases where systematic study has been long discontinued. The average schoolboy or girl would experience little difficulty in memorizing a whole column of new words and terms, even if they were not familiar English ones, but this is surely asking rather too much of many of those who come to us, full of enthusiasm, anxious to learn these subjects. Are we quite certain that our methods are really suited to this class of student? Many years of experience have taught me that some, at least, are disheartened at the end of the very first lesson, which is frequently described as 'dry'. How far is this descriptive adjective justified, and could the approach to these subjects be made more interesting right from the beginning 7 Let me try to put it this way. How many of my readers have ever commenced to learn a foreign language 7 Do you recall the thrill you experienced when, ha ving struggled through the strange

alphabet with the appropriate sounds of each letter, learned a few nouns and verbs and memorized tables of tenses and declensions, you at last actually formed a sentence in the new language or translated 'My father is a man'? Now, suppose a very clever teacher had made it possible for you to form that sentence or translate that simple passage during the first lesson, what zest would have been infused into the remainder of the course. Becomes Impatient When a student takes his place for the first bme in one of our classes he is full of enthusiasm, looking forward to being able to 'do something.' Is it surprising if he becomes impatient when he has to sit through a 'lecture' consisting of a list of reasons for learning the subject, the qualifications he should possess or acquire, the scope of the subject, golden rules, how he (she) should dress (nursing), duties of first aider or nurse, observation, etc.7 Surely his very presence there is evidence that he has already realized the need for this knowledge. Could we not, as in the case of the hypothetical language teacher above, by-pass these first 'dry' preliminaries and present the student with something concrete right at the beginning 7 A full appreciation of these early principles is readily admitted by all of us, but they could be distributed throughout the course and taught piecemeal as occasion arose. The tedium of this first lesson would then be avoided. The whole course would require very careful study and preparation, but it would be worth while. We have already advanced far from some (shall I say few 7) of those early 'lecturers' who sat at the table and read the 'text-book to their victims verbatim. It is not my intention to attempt to teach our lecturers their job, for the increasing number of certificates issued from year to year testify to the success of their efforts. At the same time an exchange of ideas, based upon experience, cannot fail to prove mutually helpful. I cannot help wondering if some of those students who do slip through our fingers might be retained if more regard were paid to these temperaments, and methods modified accordingly.

Roll a Piece of Putty It is well-known that more is learned through the eye than through the ear, and much of the success of a lecture depends upon the attention one is able to secure right at the commencement of a subject. In teaching osteology I have found that nothing is more boring to the student than to have to listen to a string of Latin names, and to be told that, in order to pass his examination, it will be necessary for him to memorise all of these. To many it is almost frightening. My own approach to this subject has frequently been to roll a piece of semi-soft putty into a pillar and attempt to make it stand on end on the table with, of course, no success until I had demonstrated the support which can be given by the introduction of a hairpin through the long axis. Two shorter rolls of putty with a match-stick through them illustrate the same principle in the case of the upper limbs. From this it is but a short step to the mechanics of support and movement. In teaching respiration the classical experiment with a Winchester, two glass tubes and a child's bladder requires little apparatus and no preparation, but these ocular demonstrations do most certainly arrest attention at the beginning, and no lecturer should experience any difficulty in retaining rapt attention right through to the end of the lecture. The teaching of practical work, also, requires some very serious thought. 'Demonstrators' should be most carefully selected. I have known cases in which a whole division or detachment, including newly-joined members, have been turned loose upon a class as 'demonstrators', with disastrous results. On the other hand a practice which obtains in some cases of a 'demonstrator' standing on the platform and illustrating half-a-dozen bandages in succession, and expecting new students to memorise all the details, is strongly to be condemned. Every student should be made to practice each bandage thoroughly until quite proficient before passing on to the next, but even this, by a tactful and experienced demonstrator, can be deprived of any monotony and made really interesting. Continued on opposite page

FIRST AID & NURSING, MAY/JUNE 1956

Competitions British Electricity Ambulance Centre Competitions

N0 less than ]2 men's and 11 women's teams took part in the British Electricity Ambulance Centre Finals at the Porchester Halls, Bayswater, organized by the St. John Ambulance Association for the magnificent Challenge Trophies' presented by the Association. The competitions consisted of both team and dual practical tests for each sex, and a high standard of efficiency was exhibited. Men's Team Test, set and judged by Dr. V. C. J. Harris, ofSt. Bees: The members of the team are walking in the country when they come across a camper who has fallen from a tree. He has also spilled boiling water over his arm whilst preparing to bathe his wounds. Injuries : Scald, with blisters forming, severe wound on front of forearm , compound fracture of right tibia and haemorrhagic shock. Women's Team Test, set and judged by Dr. Gordon Gilles, of Burton-on-Trent: The team is called to give assistance to a girl carrying a pan of boiling water, who has slipped on the greasy floor. Injuries : Large wound of right wrist with glass embedded, Colles' fracture of upper limb, scalds on legs with blisters forming, strained calf muscle and nerve shock.

This photograph shows the preparation of a 'casualty' ready for one of the tests at the Finals of the 1956 National First Aid Competitions of the Central Electricity Authority, which were held recently at the Porchester Halls, London. The' victim' being very realistically made up, is Miss Margaret March, and ' inflicting the wounds' is Fred Argyle, formerly of 'L' Division, Metropolitan Police.

Men's Dual Practical Tests, set and judged by Dr. J. A. Hanraty, of Deal: Nos. 1 and 2 find a man sitting on the ground holding his right elbow. Injuries: Fractured clavicle, lacerated wound of palm and nerve shock. Nos. 3 and 4 are asked by a woman to attend to a man who has fallen from a ladder. Injuries: Apoplexy and simple fracture of 6th and 7th ribs. Women's Dual Tests, set and judged by Dr. Lancelot K Wills, of London: Nos. 1 and 2 find an elderly man lying on the floor. Injuries: Apoplexy and sprained anklejoint. Nos. 3 and 4 have to prepare a room for the reception of a patient suffering from a fracture of the lower limb. Mr. Horace F. Parshall, T.D., M.A. (Oxon.), Director-General of the St. John Ambulance Association, occupied the chair at the presentation after the competitions. In introducing Sir Henry Self, KC.B., KC.M.G., KB.E., Deputy Chairman (Administration) Central Electricity Authority, he expressed the appreciation of all at the honour which they felt in having Sir Henry with them that day. The interest which the Chairman and Deputy Chairman of the Electricity Authority had shown in the ambulance movement was evidence of their appreciation of the work of the ambulance movement. There were many that he would like to thank for their part, but he felt that he must mention the Associated British Picture Corporation Ltd., who, time after time, supplied, erected and removed the scenery which, in conjunction with the trained 'patients' and 'fakers', aU voluntary workers, contributed so much to the realism of the tests. He was very pleased to see there Lt.-General Sir Otto Lund, KC.B., D.S.O., the Commissioner-in-Chief of the St. John Ambulance Brigade, with whom he had worked for many years. Stewards, timekeepers and others deserved their thanks, but, perhaps, the judges, members of that overworked medical profession, could never be sufficiently thanked for their part in the success of these competitions, for it was from them that we gained all our instruction, and their comments were always most valuable. He asked Dr. Harris to comment upon the Men's Team Test. Dr. Harris commenced by saying that their position was an unenviable one, for they must either be unmitigated liars or life would not be worth living (laughter). However, he proposed to be frank, and he believed that the competitors would appreciate this. Of the home truths he told them, two were important. Consideration of the best means of transport was most important. To have carried the patient on the stretcher to the nearest farm would have taken two hours. Could they not have put forward some better suggestion than that? Further, they must show some appreciation of the situation. It must have been perfectly obvious that the yokel, of whom they asked, 'Are you a doctor?' was a nitwit. They must try to cultivate observation. Dr. Gilles, who judged the Women's Team Test, spoke for Dr. Wills and himself, and both were unanimous in congratulating all the teams upon their

5 excellent work. The team test was a s!mple one and presented, upon consideratlOn, five conditions. In the apoplexy case many had not thought to examine the spine. Another questi0,n he asked was, 'Why did some of them fall to move the bed from the wall?' One team asked if there were a gasfire, forgetting that they were in an isolated country spot, far removed from gas mains. Careful handling of dressings had been n.oted. Both judges expressed appreciatlOn of the work of the women's teams. Here followed the announcement of the results:

MEN

1. Fulham ......... (winning the Challenge Trophy) 2. Oldham ... ... ... ... 3. Stourport 4. Derby 5. Hull 6. Brighton ... 7. Northmet 8. Swindon ... 9. Northwich 10. Tir John 11. Pool 12. York

304 283 l 275 273 272t 265t 264 ~

263 248

246~

245 244t

WOMEN 1. Swindon ... ... .. . .. . 318 (winning the Cb allenge Trophy) 2. Kingston ... ... ... 288 3. Barnstaple 283 4. Gloucester 264 5. Blackburn... 263 6. Newcastle-on-Tyne 262t 7. Kettering 258 8. Milton Hall 255 9. Bexleyheath 242 10. Sheffield 196 11. Winsley Street 191 In presenting the trophies, Sir Henry Self proved that his interest in first aid work How Shall We Teach .. . ?-Continued

In nursing one of the most outstanding weaknesses is to be found in the laying up of trays and trolleys, merely because time has not been allowed for each student to have an opportunity of individually practicing. On the other hand I have seen some teachers most insistent upon this. Regional Anatomy Finally, the competitions show that there is one subject which, generally speaking, does not always receive the attention it should, and that is regional anatomy, landmarks and surface markings. I have seen the 5th and 6th ribs palpated in the most extraordinary positions! Yes, it is most gratifying to hear the judges at the competitions congratulating the teams upon the steady rise in the standard of efficiency to be seen each year, but is this rise reflected in the movement generally?

Competitions ..• was far more than superficial, f<;>r he po-sessed a thorough knowledge (wIthout notes) of the successes which had ~een achieved in former years by the .varlous teams from the Electricity Authonty, and he attributed these successes largely to the grand work wbic.h had been done by the Authority's MedIcal Officer, Dr. J:>rm~le . 'The knowledge of first aid. a.n~ nursmg, . he said, 'is a valuable acqu.lsItlOn, en~bllOg ou to give of your best m the ~ervlce .of ~an.' He said that the British .Electrlclty Authority was desperately keen m furthering this great movement. The St. John Ambulance Association was supremely national in character,. and they. were all grateful to it for havmg orgaDlzed these valuable competitions. Th.ey would. be pleased to learn that the Bngade recr~Jt.ed ]28 new members from the ElectriCIty Authority last year. . Ml. Parshall thanked Sir Henry for hIS most inspiring speech, and stated that. tpe Association was proud of the ElectriCIty Authority Ambulance Centre . .He concluded by thanking both Dr. Prmgle an.d Mr. Willett, the Centre's secretary, for their magnificent work.

National Dock Labour Board Perhaps it would be difficult to suggest any community, to the members of WhI~h a knowledge of first aid is more essentIal than that engaged in and around the docks. That this fact is fully realized was aptly demonstrated at Toynbee H~ll, Lon~on, when teams representing vanous sectlOns of this important community competed f~r trophies in the .Second Annual CompetItions of the atlOnal Dock Labour Board Ambulance Centre of the S1. John Ambulance Association. ]n addition. to the competitions ~h~r.e were two exhlb.ltlOns,. a!1 industrial exhibltlOn and a first aId exhI~I tion. The industrial exhibition, stag;ed m the Lecture Hall, illustrated the handlmg of cargo, ships' gear and dockers'. pe~sonal gear, together with a photographlC dIsplay of the Docks in the Port of London. ThIS interesting and instructive exhibit had been alTanged by the Assistant Manager and Welfare Officers of the Royal Group of Docks (London). In the Aves Room members of the St. John Ambulance Association demonstrated the art of 'faking', or making-up ~asu.alties, which makes so valuable a contnbutlOn to the realism of competitions today. The acting of 'casualties' was also demonstrated by St. John-trained personnel. In another part of this hall industnal nurses from the Port of London Authority demonstrated various nursing techniques like removi,ng foreign bodies from the eye, etc. At illtervals during the day a film was shown illustrating 'First Aid in the Docks.' STAFF COMPETITIONS Team Test: The team is called to an office, where they find a clerk on the Aoor with a heavy steel cabinet across his legs. Jnjuries: Compound fracture of right leg, Colles' fracture of left forearm, shock. Duo-Practical Tests: os. 1 and 3 find a man who has had his hand caught between the window frame

FIRST AID & NURSI G , MAY/JUNE ]956 and the sill. He has been released and is sitting in a chair. . Injuries: Fracture of nght metac~rpus, Wound on back of hand, nerve .shocrC. os. 2 and 4 find a man lymg on the ground groaning having fallen down the office steps. Injuries: Suspected fracture of right pateila nerve shock. The;e two tests and the team test were set and judged by Dr. R. Rem\ ick. Individual Test: A man is entering the room when the door is suddenly opened from the other side, and the high handle of the door strikes him on the chest. Injuries: Simple fractures .of 7th and 8th left ribs, nerve shock. The test was set and judged by Dr. J. Fairlee. DOCK WORKERS' COMPETITIOi'\S Team Test: . . The team, members of a gang workwg m the ship's hold, see two heavy cases fall on one of their mates. . Injuries: Suspected fracture of sl?me (lumbar region). simple fracture of r~ght tibia (mid-shaft), simple fracture of nght forearm, wound of right hand. The test was set and judged by Dr. G. M. Sha\\ Smith. Duo-Practical Tests: . os . 1 and 3 see a man, who IS engaged in a friendly wrestling match, slip and fall to the ground. . . Injuries: Fracture of nght claVIcle, strained right calf muscle, shock. ' os. 2 and 4 find a man collapsed in the office. . Injuries: Apoplexy, fracture "f lower Ja\\. These were set and judged by Dr. F. H. Taylor. . At the presentation ceremony the .chalr was occupied by their beloved PreSIdent, Rt. Hon. Lord Crook, K.SU., J ..P ., who was supported by Lieut. General SIT Henry Pownall, K.C.B ., K.B.E., D.S .O. (Chancellor of the Order of Sf. John ). Mr. Horace F. Parshall , TD., M.A. (Director-<!e~eral of the St. John Ambulance ASSOCiatIOn), Lieut.-General Sir Otto Lund, K.C.B., D.S.O. (Commissioner-in-Chief, the St. John Ambulance Brigade), Lieut-Calonel J. E. F. Gueritz, M.A. (Secretary, the SI. John Ambulance Association) , Mr. G. E. Craft (Competition Secretary, the Sf. Jopn Ambulance Association), Mr. Arthur Bud (Chairman of the N.D.L.B. Ambulance Centre), Mr. F. G. Thomas, M.A. (Secretary of the .D .LB. Ambulance Ce~~re) and Mr. David Hallard (CompetltlOn Secretary of the .D.L. B. Ambulance Centre). . [n opening the proceedipgs the Ch~llTIlan expressed his pleasure. IO welcomIng sa many visitors, and s~ld th.at th~y were particularly fortunate 10 haVIng wlth them so many representatives of the Order of St. John. They were always glad to hear the judges' comments on these occasions, and he asked Dr. Fairlee to lead. Dr. Fairlee said that, whilst the standard had been good in the Staff Individual Tests, there had been some omissions. Not one had attempted to remove the patient from the door, and only one had tried to distinguish a simple from a compound frac-

ture. One member had failed to diagnose the fracture at all. More use should be made of bystanders. All had been good in their treatment of shock. . . Dr. Taylor said that he dId not Itke ta hear passages recited word for word from the text-book. He had had. to .make allowance for stage-fright, espeCially III the case of the ladies. On behalf of Dr. Renwick , who had had to leave early, I:e said that he had been asked to state that 10 the Staff Team Test the bandages should have been tighter. . . Dr. Shaw Smith emphaSized th~ Impo.rtance of confirming the diagnOSIs, wl11ch was often made upon very flimsy evidence. Examination of the patient had been reasonably good, but the handling of the patient had sometimes. been r.ough. He had not been entirely satisfied With .the way in which extension had been carned. out. 'Put yourself in the position the pallent,' he advised. Much valuable tIme had been wasted in seeking winches and other mechanical aids. The patient had often been transported before having been properly prepared. They obviously I:ad the knowledge, but lacked the .practlce. 'Much more practice,' he emphaSIzed, and concluded by saying that they had all learned something that day. Sir Henry Pownall thanked the Centre for having invited him to come there that day. He had been impressed by the fact that so many had gi\en up their Saturday to attend, both teams and audience. . It was most encouraging. He agreed With Lord Crook in cangratulating them ~pan the progress which had been made III so short a time. He had been very pleased with his visit. .. Sir Otto Lund also expressed hIS gra~l~ude for the imitation. These campetltlOns \\'ere of the greatest importance i~ encouraging recruiting for the Bnga~e. 'Above all things,' he said, 'we must maI~ tain efficiency.' He hoped that first aId would grow around the ports, and that they would be able to establish units of the Brigade there. They must not lose .si~ht of the fact, however, that.t~ey are t~alOlOg t? be of service to all Citizens besldes thelr comrades in the docks. He was pleased to say that the numbers in the Brigade were grov.ing. 'Why not make these teams the nucleus of a Division ')' he concluded. Mr. Parshall felt that it was most encouraging to have heard so much <?f the progress made in the dacks. In fact, It had left him very little to say. He congratulated the teams upon the work which they had done that day, and particularly thanked Lord Crook for the very valuable encouragement he had always given to the work. He concluded by saying that he lo?ked forward to great things from the atJOnal Dock Labour Board Ambulance Centre. Mr. Bird paid high tributes to Mr. Hallard, Mr. Craft and Miss Cheal. The results of the campetitions were then announced:

DOCK WORKERS' COMPETITION 1. Yarmouth ... . .. 310 (winning the ' Port Employers' Trophy) 2. Swansea 268 3. Middlesbrough 256 4. Grimsby ... 253 5. Southampton 250 6. Liverpool 245

FIRST AID &

URSI G, MAY JU

E 1956

Competitions ... 7. Grangemouth 8. Ayrshire 9. Bostan 10. Glasgow ... 11. Bo 'ness

244 194 ] 88 169 153

STAFF COMPETITIO:'\'

1. Head Office

292

(winning the 'W. Trophy) 2. Liverpool 3. Landon ... 4. Middlesbrough 5. Newcastle

C. Ho\\' 291 287 244 183

STAFF h\1)IVrnUAL COMPETITIO:";S 1. Miss Constable, Head Office 150 2. Mr. R . Atkinson, Li\erpool. 137 3. Mr. J. Cheeseman, ) London . tied 114 Mr. W. Pollard, J London 5. Mis M. Stobb, ' ewcaStle 113 6. Mr. E. Barker. Head Office III 7. Mr. M. Maxv,:ell, Liverpool 108 8. Mr. E. Hanson, ) Middlesbrough tied 93 Miss J. Matheson, ) Li\erpool .. . 92 10. Miss M. Bell, Liverpool 1 I. Mr . S. Donaldson, Newcastle 91 12. Mr. F. Martin-Dye, Head Office 3 77 13. Mr. A. Forster, ewcastle 14. Mr. K. Ste\enson, Middlesbrough 72 67 15. Mi s J . Donald, ewcastle ]n presenting the trophies His Lordship said 'We are famous for record. and are pro~d to ha\'e here with us toda):' in th! hall the youngest member of the Brtgade. He paid a high tribute to the team work of the members. Of the many he would like to thank for their contributions to the ucces of the event he mentioned the St. Jahn Ambulance Association, the Warden of Toynbee Hall , the A.RC. Film Studios and the many firms who had so kindly lent exhibition material, as well as the many voluntary helpers too numerous to mention individually.

London Transport An added interest was gi\en to thi popular London event thi year \>"hen it became known that a further trophy had been presented by Dr. L G. orm.an, the Chief Medical Officer, v. hose deep lOterest in the work is so well-known. The ten teams competing were the survi\ors of the 64 which had submitted to the gruell111g preliminary tests held in th~ nine Di trict . The Competition was held 111 the Borough Polytechnic and was watched by a large and enthusiastic audience. As usual, the tests proved most interesting, the team test being as follows: . . , The team members arc wallll1g at a bus stop opposite a public house, wher.e a lorry is unloading beer barrels. The drJver calls to the cellarman to open the trap doors and thinking that they are unlocked, he ride~ up on the Ii The doors are bolted, and he i cru'hed. lIe can only be released by gaing through the public ho~se. lnjuric ~: Unconsciousness, conCll s~on, laceration or rigi1t arm and fractured right leg.

rt.

In the dual practical tests, as. I and 4 are called in by a woman to attend a man who has swallowed an overdose of sleeping tablets, and in falling has knocked over a pot of tea. Patient is not breathing and has scalds on left hand and forearm. os. 2 and 3 are visiting a country inn when they hear a cry from the saloon bar. On entering they find the inn-keeper on the floor. He is suffering from an epileptic fit and in falling has sustained a bruise on the forehead and a Colles' fracture of the left forearm. The team test was set and judged by Dr. Margaret R. Thomson, of Wanstead. and the Dual and Oral tests were set and judged by Drs. C. T. ewnham, Regional Medical Officer, British Railwavs and L. Wills, of Wembley. The presentation ceremony was presided mer by Mr. Alex J. Webb, General Superintendent (Staff and Training) Railways, who is Chairman of the Ambulance Centre. Present, also, were most of the principal officials of London Transport, and from the St. John Ambulance Association were Major A. C. White Knox, O.B.E. , M.e., M.B., Ch.B., Principal Medical Officer, Lt.-Col. J. E.F. Gueritz, M.A.(Oxon), Secretary and Mr. George E. Craft, Competition Secretary. The results of the Competition were announced a follows: 1. Baker Street (Women) ... --1-89 (winning the Challenge Shield) 2. Chiswick 4 6 (winning the orman Cup) _1. ew Cross' , 453 (winning the Probyn Shield) 4. CharIton 440 5. Peckham 'B' 438 6. Manor I louse 435 7. Romforo. 'A' 423 8. Reigate (Women) ... 416 390 9. Clapham 355 10. Chiswick (Women) The trophie were presented by Mr. G. Fernyhough, TD., Operating Manager (Country Bu e and Coaches), who was thanked by Dr. orman, Chief Medical Officer and a Vice-President .of the Centre. The Di triet Chairman, Mr. J. H. Giffin, proposed a vote of thanks ~o t?e judges f?r having so kindl) gi\en their tlille and skill that day. Mr. S. W. Harden. the Centre Secretar). thanked the teams for their continued interest in competition work and also paid tribute to the help.gi\'en by the District and Branch ecretanes, the stewards, time-keepers, 'patients', make-up arti t and the many helpers who had assisted with the organization of the competitions.

TEAM TEST Mr. Sinclair, a villager of Westross. falls from the roof of a shed he i building in the garden. Mrs. Sinclair, alarmed -at the commotion, rushes out and collides \\ ith her daughter Kate, injuring herself but not Kate. The team happens to be nearby. Injuries, Mr. Sinclair: Lacerated waund, right frontal region, with moderate haemorrhage, simple fracture of right humerus (lower third). concu ion (regains consciousness two minutes after arrival of the team), moderate shock. Mr . Sinclair: Simple fracture of right olecranon. incised wound, palm of right hand (moderate haemorrhage) , moderate shock. The judges who had kindly consented to officiate were:

British Red Cross Society Semi-Finals

City of'Lol/doll ]. Sussex 746 2. Berkshire. .. 735§ 3. orfolk... 665 orthamptonshire 643 4. The following Branche will be r~preented in the Finals for the Stanley ShIelds, to be held at Friend ' Meeting Hou e, Eu ton Road, on 2nd June,.: S?uth Lincoln hire, Sus ex, Devon hIre, Kent, Worcestershire, East Lancashire, o~th Riding of York hire and a representatJ\'e team from Scotland.

As the Eliminating Round for the B.R.CS. Finals (Stanley Shields) .are !'lot open to the pllb!ic, we .a l\\: ay~ conSIder It a privilege to receJ\'e an Im'HatlOn to attend. The two Metropolitan Rounds were both held on the same day, the County of London taking place at B.R.e.S. Headquarters in Gros\enor Crescent and t~e City of London at their Hea~qllarters 10 Pudding Lane. The team te t In each case was identical.

COllllty of Lolldoll First Aid Team Test: Dr. B. H. Pent nay. Dr. C. W. Robertson. ursing Team Test: Mis D. J. Markham, Miss M. H. E\ans. First l.Jd Oral: Dr. R . W. Barr-Bro\'vn. First Aid Practical: Dr. J. Caradoc Evans. ursing Oral: Mrs. L J. Oatway. ursing Practical: Miss M. Brailsford. Uniform: Mi s ~1. Young-Jamieson, O.B.E.

Cill' of Londoll First Aid Team Test: Dr. H. . Collier, Dr. P . H. Lomax. ursing Team Test: Mrs. L. R. Blame), fiss S. Preston, S.R. ., R .F. ., H.V. First Aid Oral: Dr. R. M. A. Orm ton. First Aid Practical: Dr. E. O. WalwynJones. Nursing Oral: fiss F. 1. Prior, S.R.N., CM.B. rursing Practical: Sister M. Davie. S.R. .. CM.B.. R.E I . Uniform: Miss aylor Smith, M.B .E. We spent half our time at each Headquarter, and were plea ed to note the high standard of efficiency. especially as the tests \\ere b) no means easy ones. Of [he man) officials present we noticed l\1iss M. E. Cra\en, R.R.e. (Matron-inChief). Dame Beryl Oli\'er, G .RE .. R.R.e. (Director of Education), ~~r. O. .S. Prentice, O.RE .. A.R.R.C (Director. City of London Branch) and other . Following are the re ult , together with the mark obtained: Coullly 0/ LOl/doll 1. South Lincolnshire 691 2. Hertfordshire 662 3. Surrey 655 4. Bedfordshire 646~ 5. Middlese-x 640~ 6. ottinghamshire 626~ 7. Somerset 625~

FIRST AID & NURSING, MAY/JUNE 1956

Competitions . ..

Metropolitan Women Police Finals Who said women police can't cook? Well more about that later. For the pres~nt we will concentrate upon the object of that large 'blue' gathering at Percy Laurie House, which was to witness the Annual First Aid Competitions for the Lady Abbiss Bowl and First Aid Con~ mit tee Trophy. The teams had to subIlllt to a team test and to dual practical tests. In the team test, which was set and judged by Dr. Lancelot Wills, they are called to a cafe, where a waitress has been attacked by a ruffian, who has inflicted three stab wounds in the chest, a wound on the scalp and then endeavoured to finish her off by strangling her with a shoe lace, as a result of which she is asphyxiated. In the dual practical test, which was set and judged by Dr. D. Towle, a boy has knocked his head against the mantel-shelf and fallen in front of the fire. He has sustained a burn on the forearm (the clothing was actually smouldering), fracture of the olecranon and a bruise on the forehead. In opening the presentation proceedings, the Chairman, Miss E. C. Bather, O.B.E., Chief Superintendent, Metropolitan Women Police, said that it was a great pleasure to welcome so many there that day. Just at that time the Metropolitan Police were particularly busy, which accounted for the absence of so many of their senior officers, who always took so great an interest in the work. She read an apology from Assistant Commissioner Capt. Rymer Jones. We did, however, see, amongst others present, Deputy Com mander Franklin, O.B.E., Chief Superintendents Hefford, M.B.E., Giles, Way, Hood, Brandon and Hawkes. Miss Bather said that the comments of the judges are always of immense value to the competitors, and she invited Dr. Wills to comment upon the team test. Dr. Wills had many constructive criticisms to make, which were obviously appreciated. He commenced by saying that many of the competitors had not 'filled their papers.' There had been many things left undone which might have been done. In some cases there had been unnecessary delay in removing the constriction round the patient's neck. Some missed the punctured wound which had damaged the Ii ver. He laid particular emphasis upon the necessity of examining the back before moving the patient. In setting the test he had hoped that they would have spotted the wound before commencing artificial respiration, in which case the combined Schafer-H.N. system would not have been wise. The punctured wound had been missed in some cases because the examination had not been sufficiently complete. 'Reassurance' had been good, but it might have been a little more soothing, and he would like to have seen the turning of the patient carried out rather more gently. He feared that all had not fully realized the danger arising from the internal haemorrhage, but, on the whole, the work had been good. 'Good luck to you all,' he concluded. Dr. Towle said, 'We have been having some fun in the room upstairs.' He reminded them of one or two details of the

dual test. The boy had bumped his head against the mantel-shelf, and had fallen in front of the fire, and exami nation would have disclosed that his shirt-sleeve was actually smouldering. It was hoped that they would immediately remove him from the fire. The burn should have been covered immediately. A simple dry dressing was all that was needed, as medical aid would soon have been available. He reminded his hearers that in England an ambulance can always be quickly obtained, and it is therefore necessary for the first aider to do only the minimum possible. The row the boy kicked up when moved should have indicated that there was something more than the burn. He wanted them to immobilize the elbow. The forehead should, also, have been more thoroughly examined. Then there was 'Mum'. She needed consolation, which in some cases she did not get. Dr. Towle concluded by saying that the standard was excelJent, and was still rapidly improving. The results were then announced: 1. No.4 District, 'A' team 327 (winning the 'Lady Abbiss' Bowl) 2. No.1 District, 'A' team 325 3. o. 3 District, 'A' team 320-24. No. I District, 'B' team 312t 5. No.3 District, 'B' team 305t 6. No.2 District, 'B' team ... 290 7. NO.4 District, 'B' team 289 8. No.2 D istrict, 'A' team 267t In presenting the trophies Commander Childs expressed the very great pleasure he experienced in being there that day, and he felt that it was most gratifying to learn of the high standard which had been attained in first aid. He did think, however, that the team test was a most diabolical one! He took a great interest in competitions because he realized the objects were to improve the standard of work. Miss Bather expressed the gratitude of all to the judges who were always so ready and wilJing to help this great cause. She thanked, also, the stewards, the 'patients', the make-up artists and all who had contributed to the success of the event. They were especially grateful to the competition secretary, Inspector Williamson, who had been so ably assisted by Sergt. Morley. The First Aid Committee, under its chairman, Supt. Miss E. Yates, had given them every encouragement. This report would be far from complete without a reference. to the excellent catering arrangements which had been carried out entirely by the 'ladies in blue' under the direction of Mrs. Harding. The whole of the cooking had been done by them-and can they make pastries? Oh, boy!

From a seat in the audienee Electricity Finals When once extension has been applied, hold on like grim death to a mopstick. A cigarette is seldom offered to a patient by a women's team . An exception. One female competitor lighted it-and commenced to draw!

FIRST AID & NURSING, MAY/JUNE 1956

The canteen was empty-'Sold out.' Study general condition first. Fractures can wait. 'Nuisances' should be more obstructive. Why palpate for fracture three times? Don't order tea until the patient is conscious. It gets cold. Why not pull the bed from the wall to enable nurses to work each side? Those enveloped corners! That unsupported head in blanket lift ! How quickly that water boiled! Wife should not have suggested tea. This should have been left to the competitors. 'Weather is warm.' How did he know? As a matter of fact, it was a 'dry, cold day.' Use right hand (self and patient) for taking pulse unless contra-indicated. 'Come on Bill' right in the middle of a 'phone call. 'Bystanders' should not exhibit technical knowledge. It is assumed that they are not first-aiders. Why do male competitors always want to embrace the girl who calls them?

The Repair

Squad When you reccive a wound or a burn, your body mobilizes its repair squad to make good the damage. Infection by bacter.ia hinders the repair squad in its work and may even oycn\helm it, so that the wound heals slowly or not at all.

some of the older antiseptics do quite effectiyely.

Dock Labour Board Finals We were puzzled until we discovered that some were working to the St. Andrews text-book. Some were afraid to depart from the strict letter of the text-book. There were some obviously inexperienced teams, but they did well. He was uncertain of the proportion of spirit to water. Don't waste an ambulance if a sitting case car will do. Few tested the ability to swallow. One team marched on like a company of guards. Judge: 'It's not me that's bleeding, it is the patient.'

But no antiseptic, however efficient, will heal a wound; only the repair squad can do that. The drawback of the older antiseptics, such as acriflavine, tincture of iodine, propamidine, etc., is that they interfere with the repair squ<ld's acti\ ities -

and thus themselves slow dov.'ll the process of

healing. ( Furacin " however, is an entirel), new type of germicide, which destroys bacteria and preYents

B.R. C.S. Eliminating Competitions We saw a perfect blanket lift by Sussex 114. 'Don't worry' before even seeing the patient. She should not have needed instruction in blanketing stretcher. Was it necessary for three to carry one cushion? Why not ask Kate to help with blanket lift? The more the merrier. It was not the head but the legs this time which were unsupported. Was a stretcher really required for so short a distance? Metropolita n Women P olice That burn should have been covered more quickly. Don't put the hot-water bottle on his tummy. Those detailed instructions by the leader should not have been necessary. Changing bearers in A. R . must be done without interrupting the rhythm. Many questions which should have been asked at first were left until half-way through the test. 'Don't you worry. You'll be alright'16 times by one team! 'I'm keeping her covered.' She was half undressed. Where did she think ice would be produced from? Surely the bloodstains should have suggested the necessity of exposing the wound.

infection must be pre\"ented or suppressed, <lnd this

infection outstandingly well, and yet lea\"es the repair squad unharmed to get on with hcaling the wound. For this reason, (Furacin' is becoming more and more widely llsed in hospitals and first-aid rooms in this countr), and America. Made up as an ointment, it is easy to handle, and table, and is avaHable in a range of pack sizes to suit all users.

FURACIN *SOLUBLE OINTMENT the potent antibacte rjal especially designed for wounds and burns

--- .'

Available in I-oz. tubes, 4-oz. and 16-oz. jars Further details on request

MENLEY & JAMES , LIM ITED COLDHAR.BOUR. LAN E. LON DON, S.E.5 'Tn/de mark

•• •• •• ••••••••••••••

FN75

FIRST AID & NURSING, MAY/JUNE 1956

Skeletons for Teaching Purposes HE advantages o~ use of skelet?ns in the first aId and medIcal world to facilitate teaching and general education is now fully appreciated. Educational and Scientific Plastics Ltd., of 71 Brighton Road, Hooley, Coulsdon, Surrey, manufacture a complete range of synthetic osteological models, which have all been formed from the actual human specimens and are entirely correct from an anatonucal point of view. Models are resistant to any climatic conditions-heat, moisture, acids, alkalis and most organic solventsand are more durable than the natural bone. The surface of a model (which has the appearance of natural bone) readily lends itself for colouring, painting and marking. All models are washable. Quotations for the overhaul and repair of existing teaching models of all types are given by the Company. The illustration is of the Miniature Skeleton (a table model) which is approximately 26 in. high. It has been designed to meet the growing demand for a comparatively accurate small-scale model of the human

Educational and Scientific Plastics' miniature skeleton.

model is very difficult to break and skeleton for the teaching of basic any bone can be easily replaced, if anatomy in schools and first aid worn or broken, by another at a cost classes in particular. It is produced in lightweight and of a few shillings. Seventy-three durable synthetic material having bones are numbered and referenced the colour and general appearance of on a chart attached to the inside of bone, and it demonstrates all the the cabinet door. major anatomical markings which The jaw is movable, the ribs, might be required for teaching hands, feet and spinal column are purposes. It is articulated at the made of soft plastic, and all bones main joints, i.e., shoulder, wrist, hip of hard plastic. The skeleton is and ankle to show the relevant coloured on one side only to denote joint movements. The hands and muscular origins and insertions. feet whilst moulded in one piece The bones are so articulated as to each show the main bone subgive the correct joint movements. divisions. The skull (with articuThe cabinet is equipped with lock lated lower mandible) shows the and key; the price is £10 ISs. Od., main suture lines to facilitate the complete with cabinet and chart. demonstration of the major comAs well as suitable for teaching ponent elements of the human skull. first aid and nursing to public bodies, The rib cage and spinal column are these skeletons are also ideal for made in a slightly flexible material teachi ng first aid to the relevant which renders the entire model personnel at factories, plants, mines, suitable for rough handling. The etc. relative size of the miniature skeleton can be assessed by comparing the The Blaine miniature skeleton illustration shown here with the made by Scientific and human skull also shown. Industrial Models and AppliThe price is as follows: ances Ltd. Sam 60. Miniature skeleton£8 5s. Od. Metal stand-ISs. Od. Sam 60a. Qpaq ue plastic cover (flexible) to slip over skeleton-6s. 9d. Sam 60b. Special box with handle for permanent storage, etc.-£2 6s. Sam 60c. With muscular a ttachments painted on on~ side-£ 10 9s. Od. Sam 60d. Key for a15ove- 17s. 6d. Other models are: an articulated sculptured skeleton, miniature torso, skull (and mandible), head and neck, brain, human larynx, human eye, heart, human ear, kidney models, legs and feet, hands, obstetric pelvis, three month old child, etc. The majority of models are flexible.

FIRST AID & NURSING, MAY/JUNE 1956

London Ambulance ServiceStatistics for 1955 FIGURES are now available of the work of the London Ambulance Service during 1955. The number of cases dealt with and the distances travelled continue to rise. During the year the Accident Section dealt with 96,661 emergency calls an increase of 4,2_60 over 1954. The General Section carried out 462,615 journeys in 1955 (compared with 448,004 in J 954) and conveyed 851,997 patients a distance of -3,856,850 miles. ACCIDENT SECTION In 1955 the Accident Section of the London Ambulance Service dealt with

96,661 .emergency calls-compared with 92,401 In 1954 and 90,896 in 1953. 45 ambulances were in commission, operating from the 20 accident ambulance stations· they covered 488,292 miles, an increase of 21,877 over 1954. The average time taken to reach the scene of the calls was 7.4 minutes, and to reach s~reet accidents the average time was 6·7 mlOutes. These compare with 7.8 mmutes and 7.1 minutes respectively in 1954. To reach the scene of the emergency, attend the patient and arrive at hospital the average tim;) was 21.5 minutes compared with 21.6 minutes in 1954. ' Fridays and Saturdays were still the busiest days of the week, with averages of

293 <l;nd 281 call~ respectively, and Sunday remamed the qUIetest day with an average of 202 calls. The month with the most calls was December (287 daily average) and the months with the fewest calls were February (253 daily average) and January (255 daily average). The busiest time of day for the Accident Section (all types of emergency calls) was from noon to I p.m. (5,651 caUs during the year) and the quietest from 5 to 6 a.m. (I ,9~3 calls during the year). As in prevIOus years most street accidents occurred from 5 to 6 p.m. (l,548), most assaults. from 11 p.m ..to midnight (442); and as IS usual, maternity cases were most numerous during the night.

Miscellaneous Advertisements

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S.l.A.B. Car Badges, 30s. S.l.A.B. Badge Wall Shields, 26s. 6d. S.l.A .B. Gold cased crested Cuff Links, 50s. S.J .A.B. Badge Ladies' Brooches , 2I s., Trophy Shields supplied. Medal ribbons 9d. each on buckram for sewing on uniforms, 1s. each ribbon if mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for leaflets. - Montague Jeffery, Outfitter, St. Giles Street, Northampton.

Sole ),Ianufaclurers :

EDUCATIONAL & SCIENTIFIC PLASTICS LTD. 71 Brighton Road, Hooley, Coulsdon, Surrey Tel: Downland 2402

GARROULD'S for the

Regulation Uniform for

OFFICERS

MEMBERS

(Female only) OF THE

New Plastic Miniature Skeleton The Blaine miniature skeleton has recently been put on the market. This is made by Scientific and Industrial Models and Appliances Ltd., and is handled exclusively by S. H. Richardson, 25 Rutland Street, London, S.W.7. This model, which is illustrated, is 27 in. high and housed in a cabinet. The skeleton, suspended from a short monorail section, slides out in front of the cabinet. The

ST. JOHN AMBULANCE BRIGADE IF=========================~~~===- Established over 100 year s ~~~~==================ill

We have specialised in the making of Nurses' Uniforms for nearly 100 years and have ·a reputation for good quality materials and superb workmanship. You can order your St. John Ambulance Uniform with confidenCe", knowing that every detail will be in accordance with regulations. We shall be pleased to send full -details upon request.

I~============ E. 150-162

& R. GARROULD LTD. ~~~~~I EDGWARE

ROAD,

LONDON,

W.2

FIRST AID & NURSING, MAY/JUNE 1956

Beaders~

queries

* First-Aider~s Crossmord No. 23 Compiled by W. A. Potter

FIRST AID & NURSING, MAY/JUNE 1956 13

STRETCHERS

Qualify Nurse

are only one of the hundreds of items of FIRST AID REQUISITES which we manufacture.

Answered by Dr. A. D. Belilios

AS A

Established in 1878, and Pioneers of Industrial

L. N. D. (Claygate) writes:We have had an argument in our Division about the correct treatment to adopt when there is doubt whether the patient has broken the upper part of his humerus or the outer part of his collar bone, both injuries being near the shoulder. We lVou1d like to hear rour views and why.

First Aid, we

provide the most complete med ical service to

IN THE ARMY **

industry. Send for Catalogue

Answer Personally I should adopt the standard treatment for fracture of the upper limb when the elbow can be bent with difficulty. As an alternative, it would be sufficient to place the arm in a St. John sling. The use of a narrow bandage as a ring round the affected shoulder i:; the treatment for a fractured clavicle but it might tend to increase pain if the fracture turned out to be one of the humerus.

SANOID COLLAPSIBLE STRETCHER S.I473 Well-seasoned hardwood poles. Rot-proof canvas. Malleable iron traverse bars and runners. Complete with Straps.

Price 103/ - each Carriage paid Other types available.

'Phone: BROadwell 1355

A PRODUCT ~_LL -.AJ

r/IK~~ 7PV1f'&.ffd

OLDBURY

BIRMINGHAM

T. S. M. (London) writes :-I took to a hospital the other day a young rugby footballer who had been kicked on the ear and stunned. The doctor spent quite a long time asking him questions such as details of the game, how the accident had happened, what t;me it had occurred, etc. Surely this wasn't necessary as I, the first-aider, was easily able to anSlver the questions and supply the history as we are taught to do.

Answer The doctor was testing the memory of the patient. In concussion of the brain of which his case may have been an example, the patient cannot remember the recent past, e.g. just the details you mention. Mental confusion, defective memory or even vagueness would he sufficient to justify a provisional diagnosis of concussion and to give treatment accordingly. S. E. B. (Worthing) writes:1 am the first-aider in charge of the first aid room of our factory.

Continued at bottom of page 14

RUTIN-'T' ACROSS 1. The ductless glands (9,6) 9. Cortisone producer (7) 10. How red oats may be cooked (7) 11. Middle part of bones... (3) 12. Self (3) 13. Moving way in which many return in numbers (7) 15. Grain providing tetanus pro(4) phylactic 16. Leaning cot present at birth... (10) 19. Poison producing R.N. chin stye (10) 20. Kept at arm's length ... (4) 22. It's a lie! (7) 25. Hare is often seen in front (3) 26. Bird in the mucous membranes (3) 27. May mar good work-and kill the mountaineer (3,4) 28. Forceps for Handling sterile (7) dressings 29. Sign of 19 is nothing to laugh about (5,10)

DOWN 2. Protector of brain hidden at a murder 3. Disease in the heavens? 4. Northern dwelling 5. Left the straight and narrow path ... 6. Many months begin a great desire 7. Animal symbol 8. Doctor's orders 9. Spiritless fun in the eye? 14. Gasteropod has nails 17. Due to injury ... 18. 20 grains of conscience 21. Seat of bad temper, according to the ancients 23. Braid of hair ... 24. Indicates 7 25. Easily understood

(4,5) (6) (5) (5) (8) (5) (7,6) (7,6) (5) (9) (8)

(6) (5) (5) (5)

SOLUTION TO CROSSWORD No. 22 ACROSS 1, Doorpost; 5, Relief; 10, Claimed; 11, Masseur; 12, Omit; 13, Anvil; 15, Tot; 18, Issue; 19, Alkali; 21, Ate; 22, Insane; 24, Vomer; 27, Era; 28, Clove; 31, Hair; 34, III wind; 35, Sciatic; 36, Extend; 37, Backache.

DOWN 1, Doctor; 2, Ovaries ; 3, Pump; 4, Sedan; 6, Ease; 7, Inertia; 8, First aid; 9, Impi; 14, Vertigo; 16, Funny; 17, Blood; 20, Lifeline; 23, Scarlet; 25, Elastic; 26, Troche; 29, Lady; 30, Vista; 32, Lion; 33, Milk.

for HIGH BLOOD PRESSURE

* Here's your chance to train to be a nurse in the happy companionship of the Army. In Q.A.R.A.N.C. the independence and adventure of Army life are yours for the asking-plus all the training you need to pass the S.R.N. exam. and receive a commission. There are also many specialist posts, in such branches as dental hygiene, radiography and physiotherapy, in which you will find wide scope and fresh interests in the service of the Queen. There's a leaflet all about it-post this coupon today.

To sufferers from this complaint and associated disord ers comes welcome news of an inex pensive everyday remedy, hitherto only available in costly capsule form. RUTIN-'T' is made from the dried leaf and flower of Buck Wheat, which is the source of precious Rut in. and is at last readi ly and cheaply obtainable. Developed in the U.S.A. during the war, it was found to strengthen the blood vessels and was used to counteract internal haemorrhage caused by contact with atomic radiation. RUTIN-'T' utilises the natural properties of the plant, for both prevention and treatment of hypertension (High Blood Pressure) and it retains other benefic ia l substances including Chlorophyll. which are refined out of pharmaceutical Rutin. RUTIN-'T' acts as a preventive, delays the effects of advancing years and is a health-promoting ton ic. PRICES RUTIN-'T' in cartons for 1 month's supply

7/-

RUTIN-'T' in cartons for 2 months' supply Above prices include Postage and Purchase Tax (U.S. and Canada I Dollar and $1 75, other countries 6/- & 11 /6 post free)

13/ 3

From all good Health Stores and Chemists, or direct (rom

RUTIN PRODUCTS LTD. STATION

YARD,

WOKINGHAM,

QUEEN ALEXANDRA'S ROYAL ARMY NURSING CORPS ~---------------------------------------I I I Write for fully descriptive leaflet to War Office (MP6). YQ : 1303/ 2 London. S.W.I

I NAME .. _............................................................................ ............ _. I

BERKSHIRE

I ADDRESS .... II

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

!,----------------------------------------

FIRST AID & NURSING, MAY/JUNE 1956

Anybody can becolne a Membe.e Red Cross Society THEhasBritish announced details of a 'New Scheme'. This scheme in effect means anybody can now become a member of the Red Cross, with or without training, with or without uniform-'anyone can help,' 'everyone is needed.' Her Majesty, The Queen Mother, expressed her interest in the 'New Scheme' by visiting the Society's Headquarters. She witnessed an excellent short ' playlet', which demonstrated the work carried outata typical Red Cross Centre. The

Society aims to establish such centres in every town and village of the United Kingdom, covered by its 68 branches. Her Majesty saw exhibitions of the overseas and international work, Red Cross methods of training and aids for the disabled, and was presented by' LorJ Woolton with a badge specially designed in enamel and incorporating the Queen Mother's personal cypher. Some 200 branch representatives were presented to Her Majesty. In her address, The Queen Mother

said: 'Each Red Cross Centre can become a focus of kindness ... Your aim should be to make it possible for people to want to help ... I trust your work will go from strength to strength.' Her Majesty's address, presentation and inspection of exhibitions were carried out, as Lord Woolton said: 'In spite of personal inconvenience.' This inconvenience was due to the fact that Her Majesty had, that morning, sprained her ankle, and attended the meeting with it bandaged.

Essential Iron Iron i essential for blood formation and ineyitabh' forms the foundation in the trea tmen t of all typ;s

MR. F. H. CAVE, General Manager and

Secretary of the Mersey Docks and Harbour Board, took the opportunity as Divisional President, when presenting the A. G. Curry Cup to Private J. J. Walsh, which he won in competition within the Division, of referring to the achievements of the Division in competition with all other Brigade Divisions in the Liverpool Area. Mr. Cave said it was a matter for particular pride to him that the Board's Division, which comprised only 13 members, should, in competition with the 25 Divisions in Liverpool with a membership of 800, have succeeded in winning the very fine Macadam

Duncan Trophy for dual team work. A further outstanding achievement was in the 'Vanessa' Cup Competition, which was organized for the first time this year. In this case Private T. W. Morris, in personal competition with all other members of the Brigade in the Liverpool area, had succeeded in winning the Trophy. The third achievement was the retention of the Grace Shield which was won in competition with the Divisions in A Corps. Mr. Cave congratulated ::'; ,.perintendent Clucas on the quality of the work done by the Division and wished them continued success in the future.

Superintendent Clucas and the Mersey Docks and Harbour Board Division of the St. John Ambulance Brigade with the Trophies they have won: The Grace Shield, The Macadam Duncan Trophy and the Vanessa Cup. Sitting in the centre is Mr. Cave, General Manager and Secretary of the Mersey Docks and Harbour Board and on his right is Mr. A. B. Porter, Engineer-in-Chief, the President and Vice-President of the Division.

ourre or thi

the readiness o[ absorption of the contained ferrom salt renders the preparation a potent weapon in the treatment of all iron deficiency ana:mia.

Two o r

three capsules daily raise the ha:moo-lo bin 7-1 0° ;:,

PLASTULES Capsules are pre ented in [our \'arieties : Plain, with Li\'er Extract, with Hog Sto ma ch and with Folic Acid.

PLASTULES H1E:\IATI~·nc COl\IPOC:\D

The word' Plaslllies' is a registered trade mark of

J0 H N

\\' YET H

B ROT HER

L I 1\1 IT F D,

eli f ton H 0 use, E u s ton R 0 ad, Lon don,

:\ . \\' . I

Aid for the Brigade by

Readers Queries-Contil1l1ed

have had a lot of colds amongst the workers recently. I have been giving them a quinine medicille recommended by a firm of chemists. It does nol seem to help the It'orkers ver)' much and I am 1V0ndering if you could suggest something better.

Answer Strictly speaking, of course, the prevention and treatment of colds is not the job of a first-aider. In any case the value of quinine for the purpose you descrjbe is very doubtful. Should a worker suffer from recurrent colds he should be advised to see his own doctor so that possible You causes can be investigated. should consult your Works Medical Officer to find out his views on the treatment that you should give (if any) for those who come to the first aid room.

each week until the normal blood le\'el is attained .

An Ambulance Can Be Dangerous Achievements of Mersey Division

P LAS T U L E S

essential iron. The palatability of the cap uies ancl

----------------------------- - - - - - -- - - ----------------, --------------------------------

Doctor Robert Milne, the Southwark coroner, warned that an ambulance may be a dangerous thing, reports The El'ening News. He quoted 'an excellent letter' in the Lancet from medical officers attached to gas boards, which pleaded that when a victim of coal gas poisoning was found artificial respiration should not be stopped to place him in an ambulance where it is going to be inadequately performed in a restricted space. The Coroner added: 'There may be many cases where a person might have lived with artificial respiration being performed on the spot instead of moving the person to an ambulance.' The coroner recorded a verdict that Robert Tooley, aged 69, of Corrance Road, Brixton, gassed himself. He added that though Tooley was moved to an ambulance his life could not have been saved.

of hypochromi c microcytic anremia. Ha:matinic Compound is a reliable

BARNETT MITCHELL L TO.

MITCHELL HOUSE, 228 OLD STREET. LONDON, E.C.2

1956 PRICE

Tel: CLErkenwell 9274 (5 lines)

LIST

Officers : JACKET .................................... from £7 17 10 in Black Woaded Worsted TROUSERS...... ....................... ..." £3 2 7 Ditto OVERCOAT.......................... ... ... £11 5 7 in Quality Sheen Grey Melton RAINCOAT.. .... ........................... " £12 11 8 in Black Wool Gaberdine CAPS ....................................... ... according to rank Privates : TUN1C (Lay down Collar) ............ from £3 18 3 ;/1 Black Tartan, New Pattern (Lined sleeves 5/6d. extra)

TROUSERS........... . ......... ...... ......" OVERCOAT.... ............... . ............" CAPS. . .......................................

£2 6 0 £5 18 5 11 9

Ditto in Superfine Grey Cloth Regulation

PRICES INCLUSIVE OF PURCHASE TAX

1J,.iform Co,.tractors to H.M. 6overn',Ie,.t a",1 Public Bodies*J etc.

FIRST AID & NURSING, MAY/JUNE 1956

FiRST AID & NURSING, MAY /JUNE 1956

UNIFORMS and LADIES'

"PORTLAND"

~OATS

AMBULANCE GEAR

The Gearlllustrated(A.B.C.D.} carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients.

for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

The UP AND DOWN action is quick and easy for loading or unloading. A. Shows the two stretchers in position.

B. Shows the top stretcher lowered read y for loading. C. Illustrates the same Gear with the top stretcher frame h.nged down for use when onJy one stretcher case is carried. D. Shows the same position as in .. C • only with cushions and back rest fitted for cOllvalescent cases.

DOBSON & SONS (London)

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

UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS 154 - 164 TOOLEY STREET LONDON BRIDGE S.E.1 'Phone:

Full cCJtIl/ogue of Ambulance Equipment No. 7A will be sent on request.

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

Hop 2476 (4 lines)

'Grams:

65, WIGMORE STREET, LONDON, W.I

" Hobson, Sedist, London"

'Phone: WELbeck 0071 (Late GREAT PORTLAND STREET)

1heUNIT TRESTLE Patent applied for .

A light, rigid and efficient trestle providing two stretcher positions - one horizontal and one inclined. Designed to nest in transit veh icle or when stored . Rubber stops locate stretcher and provide handles .

THE HOUSE FOR

HUMAN SKELETONS Articulated and Disarticulated. HALF SKELETONS, Etc., Etc.

ADAM, ROUILL Y & CO. Human Osteology, Anatomy, Etc. 18 FITZROY STREET, FITZROY SQUARE, LONDON. W.1 TELEPHONE: MUSEUM 2703

&: ~OSTUMES

INVALUABLE IN COMPETITION WORK

Six trestles when stacked occupy 2 ' 10" x 2 ' 6/1 floor space.

Please write for details

BAI LLI ERE BOOKS FOR FI RST AI DERS A HANDBOOK OF

ELEMENTARY NURSING Arthur D. Belilios, M.B. , B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N. This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. It describes in simple language the basic principles an d procedures that underlie the science of nursing, and contains brief descriptions of the more common diseases, with general notes on the nursing required in each case. A complete chapter is devmed to the subject of home nursing, and the whole book provides for every first aider the essentials of nursing in a handy yet comprehensive form.

With 314 pages and 57 drawings 85. 6d.

BAILLIERE'S

HANDBOOK OF

FIRST AID AND BANDAGING by Arthur D. Belilios, M .B., B.S., D.P.H., D. K. Mulvany, M.S., M.B., F.R .C .S., F.R.C.P.I., and Katharine F. Armstrong, S.R. i ., S.C.M. First aid books, as a rule, confine themselves to injuries e.g. fractures, wounds, burns, scalds, etc., This volume is far wider in scope. It CO\'ers medical conditions of all kinds, and much of the information is not to be found easiJy elsewhere. There are chapters on case-taking, medical causes of unconsciousness, internal haemorrhage, first aid in maternity cases, first aid in spinal injuries, asphyxia, industrial poisoning, the use of morphine. 'Undoubtedly the best of its kind.' Nursing ,\Iirror. Fourth EdHion. With 488 pages and 200 drawings. 8s. 6d. Bailli~re, Tindall and Cox 7-8 Henrietta Street

London, W .C .2

Dale, Reynolds and Co. Ltd. OR

32 Finsbury Square

London, E.C.2

( ................ copy/ ies of A Handbook of Elementary Nursing Please send me ) . \ ............ .... copy/ ies of First Aid and Bandaging

G. McLOUGHLIN & CO. LTD.

for which I enclose remittance of... ........ ............ (Postage 9d . extra per volume.}

Dept. F.A., VICTORIA WORKS, OLDHAM RD., ROCHDALE, LANCS. Rochd~j~4s977

Address.

Name ........... .

A NEW ALL-METAL 2-STRETCHER AMBULANCE ON THE LAND ROVER I 07 in. W /B CHASSIS PAlCe IllYUENCE 3/6 per Annum Post Paid

up-to-date ambulance incorporates the latest aluminium alloy constructi on THIStechniques to combine toughness with comfort, and has all the mobility and tenacity afforded by a 4-wheel drive. The design provides for two stretchers and an attendant, one stretcher an d three sitting cases, or six sitting cases. Features include built-in wash basin with water supply, fully insulated body for tropical use, and adequate locker accommodation. You are invited to apply for full details of Mobile Medical Units, .Ambulances, etc., built to your particular requirements for service in any part of the world.

PILCHERS

AMBULANCE & MOBILE UNIT BUILDERS

314 Kingston Road, Wimbledon, S.W.20 Telephone: LiBerty 2350 & 7058

47 High Path, London, S. W.19 Telephone: LiBerty 3507

tPrinted by HOWARD, JONES, ROBERTS & LEETE, Ltd., 26-28 Bury Street, St. Mary Axe, London, E.C.3, and publisbed by ~the Propnetors, DALE, REYNOLDS & CO., Ltd ., at 32 Finsbury .Square, London, E.C.2, to whom all communications should be addressed.

SIGN INFECTIONS are primarily caused by Staphylococci,Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms.

ANTIPEOL is therefore

for burns and scalds,

an essential component of every First Aid and

TREATMENT

ANTIPEOL OINTMENT is both non-adhesive and

Nursing Kit.

FIRST AID & NURSING, JULY/AUGUST 1956

First Aid &

PATENT

"PORTLAND" AMBULANCE GEAR

Nursing Editor: Peter I. Craddock

The Gear iIIustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clea r for sitting patients.

This journal is published on the 20th of February, April, J une, August, October, December, by D ale, Reynolds & Co. Ltd., 32 Finsbury Squa re, L ondon, E.C.2 , for the purpose of provid ing an informa tive technical service on first aid and nursing. We welcome contributions.

The UP AND DOWN action is quick and easy for loading or unloading. A . Shows the t wo stretchers in position. B. Shows t he top s tretcher lowered read y for loading.

July / August 1956

C. Illustrates the same Gear wi th the top stretcher frame hinged doum for use when only one stretch er case is carried. D. Shows the same position as in "c . onl y wi th cushions and back rest fitt ed for con v alescen t cases.

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

In this Issue The B.R.C.S. New Scheme

Full cata logue of Ambulance Equ ipment No.7A will be sent an request .

65, WIGMORE STREET, LONDON, W.I 'Phone I WELbeck 0071

(Late GREAT PORTLAND STREET)

Medica l First Aid

A Little Known Text-B ook

Compet itions ...

From a Seat in the Audience 10

GARROULD'S

First-aider's Crosswo rd

Readers' Queri es

F ractu res

for the

Regulation Uniform

Do you know

for

OFFICERS

MEMBERS

(Female only) OF THE

ST. JOHN AMBULANCE BRIGADE

1Fr=======================- Established over 100 years ====================:;'1 We have specialised.in the making of. Nurses' Uniforms for nearly 100 years and have a reputatlon for good quality 'materials 'a nd superb workmanship. You can order your St. John Ambulance Uniform with confidence, knowing that every detail will be in accordance with regulations. We shall be pleased to send fUll details upon request.

~~~~~ E. 150-162

& R. GARROULD L TD. ~~~~~I EDGWARE

ROAD,

LONDON,

W.2

that •• • The Dalmatia n hound (' plum-pudding' dog) is the onl y kind of dog liable to gout ? Vitamin D is the onl y one no t primarily a plant product ? Professor Linus P a uling, a n America n chemist, ha s discovered tha t a ntibodies can be manufactured artificiaUy ? It is now known that th e sensation known as 'pins and needles' is ca used by the compression of an a rtery carryi ng blood to the sciatic nene ? A magnification of 25,000 diameters can now be obtained by the new R.C. A. electron microscope being manufactured by Metropolitan-Vickers ? William Harvey, who first recognised the circulation of the blood, pumped wa ter through the circulatory sys tem of a de ad man ?

A well-known public man wa once asked -to define his aim in life. Without hesitation he immediately replied . To leave the world a litt le better than 1 found it '. W hat a beautiful amb ition. Something like t his must have been in the minds of those responsible for the new comprehensive scheme which has been evolved within the British R ed Cross Society. T he importance of this development must have been realised by Her Majesty Queen Elizabeth. the Q ueen Mother, when she specificaUy referred to it upon the occassion of her recent visit to the B.R .C.S. Headquarters (repo rted in our last issue). and by Her R oyal H ighness, the Princess R oyal, who also mentioned it in her speech when presenting the trophies at the B .R .C.S. Finals (reported on another page of this issue). It is believed that there are many, possibly thousands. who admire the valuable work being done by the British R ed Cross Society, and who, whilst unable to d evote the time to studying to become trained members, would like to be identified with the movement by hel ping in some other way, either by rendering untrained service or by contributing to the much needed funds. The ew Scheme now provides these well-wishers with the opportunity of rendering practical assistance. There are now three classes of members, viz., V.A. D s., Members and Associates. The first category will consist of trained personnel who have obtained their certificates for first aid and nursing, and these will form the Corps d'Elite of the Society. It is, however, in the formation of the second class, the Members, that the pricipal innovat ion has been made, and it will consist of those men and women who, although untrained, are anxious to help the movement in some practical way. There are so many useful social welfare tasks which they can undertake, but they will no t be committed to a ny definite or regular times unless they so desire. Whenever th ey are able to spare an hour or two their services will be m ost gratefully accep ted. So numerous are these tasks waiting to be undertaken by willi ng helpers tha t it wo uld be impossi ble in a short article l ike this to enumerate them , but th e fo llowin g will provide so me idea of their var iety:

In Hospitals H ospital libraries and h ospi tal library dep ots, Picture l ibraries, Trolley shops, O ut-p atients' canteens, Lay receptionists, Visiting lonely pat ients an d chro nic sick, A rra ngin g fl owers in the wards, Escort duti es etc. In Private Houses Visiting old p eople, disab led a nd in valids, shopping and o th er errands for them: R eli ev in g relatives looki ng after chronic cases; Rea ding for a nd o therwise am usi ng t h e blind ; W atch ing for a nd r eporti ng cases where h elp is req u ired etc.

The new ba dge which will identify the Red Cross V.A.D. Members Genera l Activities Assisting in clubs for disabled. old people's clubs, old people's residential homes, meals on wheels, medical loan depots, i nvaUd transport etc. S pecial Duties D isaster relief, national emergency, international relief, overseas branches etc. Membership of this second division of the Society is open to all those men and women anxious to help their fellow creatures without distinction of race, nationality, class, creed or politics. What an opportunity to help towards that ideal state to which we all look forward, the universal brotherhood of man. Members in this category will not be expected to wear uniform unless they wish. Reference to uniform will probably prompt the question' How can the general public distinguish the trained Y.A.D. from the Member?' A special badge has been devised which will be worn by trained personnel of the Corps d'Elite on the right breast. and, although it has been in existence but a few months, is already becoming well known. A reproductio n of the badge accompanies this article, through the co urtesy of Messrs P . A . R euter Photos Ltd. It need h ardly be said that the expenses of an o rganization like the British R ed ero s Society are heavy, and it is here that the third group, the Associates. can ren der valu ab le assistance by means of their contributions. Further information respecting the New Scheme will be gladly furn ished at any B.R .C.S. County Headq uarters upon enquiry.

FIRST AID & NURSING, JULY/AUGUST 1956

A Course in Elementary First Aid of those who possess T HEa services thorough knowledge of first aid are greatly in demand. in numerous spheres. Factones, businesses, training colleges, schools etc., all have room for the man or woman who can step in and deal with an emergency if it occurs. Moreover knowledge that there is a skilled person available to deal with an accident or sudden case of illness raises morale and gives a sense of security to those who work in many fields of activity. The first-aider, however, who wishes to be a success in these various branches must be prepared to deal with any urgent condition that arises and often he will meet cases which are only briefly mentioned, if at all, in first aid books. These emergencies he will have to treat on general principles, bearing in mind the importance of quickly obtaining a doctor. It is the object of this article to describe a few of these conditions, chosen at random. Heart attacks These are very common and generally fall into one of two groups -angina pectoris and coronary thrombosis. In order to understand these conditions the first-aider must have an elementary knowledge of the anatomy and physiology of the heart. The muscle of the heart is supplied by important blood vessels known as the coronary arteries for it will be well appreciated that the heart itself needs a blood supply as much as any organ or part of the body. Disease of these blood vessels is primarily responsible for the two ailments which are being described. Angina pectoris consists of sudden attacks of severe pain in the region over the heart, the pain often reflected to the left shoulder and down the arm and accompanied by a sensation of impending death which may, in fact , occur in bad cases. The complaint is essentially due to thickening of the coronary arteries so that their walls become narrowed and hence insufficient blood reaches the muscle of the heart. The actual pain

Medical First Aid By A. David Belilios M.B., B.S. (Lond.), D.P.R. (Eng.) described is probably caused by a spasm of these vessels. A spasm means that they have suddenly become narrower and owing to this occurrence still less blood reaches the muscle and something in the nature of a cramp takes place causing the symptoms. A patient suffering from an attack of angina pectoris, stops immediately his usual occupation, stands or sits quite still leaning forwards with an anxious expression on his face, which becomes pale. The attack is often precipitated by sudden exertion, emotion or indigestion. There is little to be done from the first aid point of view. The patient should be allowed to remain motionless and should be assisted to give himself such remedies as the doctor may have prescribed for use in the emergency. These remedies may comprise small tablets which must be munched in the mouth or a small glass capsule containing a volatile liquid which the patient must inhale after crushing the capsule in his handkerchief. Immediately the attack is over the patient should be encouraged to rest and a warm or even an alcoholic drink may be given. Coronary thrombosis This occurs when a clot of blood develops in one of the branches of the coronary artery the walls of which have become roughened by disease or degeneration. The attack occurs suddenly and usually when the patient is at rest. It resembles in many ways an attack of angina pectoris but is of much longer duration. The pain occurs over the region of the heart and is reflected down one or both arms, into the back or up the neck. Severe shock usually accompanies the condition and there may be shortness of breath, cyanosis (blueness of the lips and cheeks) sweating and vomiting. First aid consists of immediate rest in a recumbent position. Shock must be treated but when the pain is at its height, it is far more important to encourage rest than to give drinks or

other energetic forms of treatment. If there is shortness of breath oxygen may be given. A doctor's services are essential since an injection of morphia will have to be given in order to relieve the pain and to reduce the shock. Subsequently removal to hospital may be required in order to give drugs which will prevent further clotting in the blood vessels and hence extension of the disease. Asthma This complaint consists of recurrent attacks of shortness of breath caused by spasm of the muscles in the smaller bronchi. The condition has many causes for example allergy which means undue sensitiveness to a foreign substance which is inhaled such as dust, pollen etc., nervous causes, and sometimes when irritation arises from other organs which are diseased such as a small growth in the nose. The attack comes on suddenly usually at night. The patient wakes up and finds that he can hardly breathe. He leans forwards or gets out of bed and stands leaning forwards by an open window. Despite his efforts, breathing is extremely difficult and is often accompanied by wheezing which is so marked that it can be heard some distance away from the patient. The attack may last for a few minutes or a few hours while sometimes it is prolonged for days. First aid consists once again in assisting to give those remedies which the doctor may have left for use in an emergency. Such may consist of tablets to be munched or dissolved in the mouth, a spray which the patient inhales or tablets to be swallowed. General nursing care is of importance and it helps the patient to be in an upright position, preferably seated or in bed, leaning forwards and grasping a support so that he can bring extra muscles of respiration into action. Should the attack not pass off medical assistance must be obtained since an injection of a drug called adrenalin may bring the attack to a quick end.

FIRST AID & NURSING, JULY /AUGUST 1956

Fever The advice of a first-aider is often sought by those who are feverish, that is to say, those who have developed a temperature which is above normal. Symptoms and signs are variable, and include, headache, aches and pains in the arms and legs, sweating and shivering alternately and a pulse rate which is above the normal. The illness often develops gradually during the course of a working day, becoming worse towards evening. Fever is really only a sign that there is something wrong with the body. It may indicate influenza , an infectious ailment such as scarlet fever, measles, etc., pneumonia or other ailments of this kind. It is obviously quite impossible for the first-aider to determine the cause, moreover even the doctor may have to keep the patient under observation for a day or two until the true nature of the iUness declares itself. Isolated The right place for a patient who is feverish is, of course, his own bed and he should be isolated from others in view of the possibility that he may be developing an infectious disease. Plenty of drinks but little food are indicated. The patient should be advised to rest and obtain medical advice. It is unwise to give aspirins or other drugs which will lower a temperature until a diagnosis of the true condition has been made.

Sore throat This common complaint is particularly prevalent in hot and dry periods of the year and is frequently due to tonsillitis. The patient suffers from all the usual symptoms and signs offever andin addition his throat is painful particularly when he swallows. Examination of the back of the mouth may reveal that the tonsils are swollen, red and inflamed and in bad cases white patches may appear upon them a sign that the patient is suffering from tonsillitis. The treatment once again is that of fever, the doctor's help being obtained since drugs such as penicillin and sulphonamides provide short cuts to the cure of this ailment. A particular watch should be kept on the patient's body for a rash since tonsillitis is often the first sign of scarlet fever.

Earache This is a common condition particularly in children. The most likely cause is that germs have entered the middle ear by way of the eustachian tube-a small channel that begins from the back of the nose. Once they have entered the middle ear, the germs set up inflammation and possibly the formation of pus; this has no means of exi t except through the eardrum which consequently becomes red and inflamed before it finally bursts or is lanced. Fever accompanies the earache which may be intense. Medical assistance should be sought as soon as possible since penicillin and the sulphonamide group of drugs will often be successful in dispersing the inflammation and preventing a 'running ear'. There is very little, therefore, for the first-aider to do. The patient should be encouraged to adopt the' sitting up' position and hot applications such as compresses can be applied provided that the doctor's opinion is not delayed. Headaches These too are very common and can be due to many causes. When a patient seeks advice for a headache the first thing to do is to take his temperature since it may be a symptom of fever in which event the treatment already described must be adopted. Severe and recurrent headaches are often due to an ailment called migraine. They may affect only one side of the head and be accompanied by giddiness, nausea and vomiting. Often there is mistiness of vision while sometimes the patient may only see half of an object at which he looks. Sufferers from migraine often carry tablets, prescribed by their doctors, to be taken on the first signs of an attack. Otherwise the patient requires rest and quiet in a darkened room; sleep, if possible, should be encouraged. In severe cases, a doctor wiLl often give an injection to cut short an attack. Eyestrain Some of the milder but also recurrent headaches are due to eyestrain and call for an examination of the eyes to see if glasses are required.

A Little-known Text-book HOW many of those who pride them. selves upon the possession of all the pnncLpal first-aid text-books printed in E~gllSh have ever heard of 'First Aid for LIfe-Boat Crews'? We have just received from the Royal National Life-boat Institution a copy of their latest edition which has been revised by Dr. Geoffrey Hale Principal Medical Officer and a membe; of the Committee of Management of the R .N.L.I. Within the scope of 38 crown octavo pages Dr. Hale has successfully collected to~ether a most vi!-luable synopsis of the subject, concentratmg particularly upon the types of injury most likely to be encountered by these gallant men in the course of their humane missions. He has wast~d no words upon anatomy and phYSIOlogy, but has referred those of his readers who wish to make a deeper study of the subject to the official text-books of the great teaching organizations. His treatment of the subject has been forthright and to the point. It was not surprising to find that 9 pages were devoted to artificial respiration, with the emphasis upon R.N. and the rocking methods, but at the same time referring to one or two which are not to be found in the orthodox text-books, but particularly useful in a boat. In watching competitions we have seen various substitutes for hot-water bottles used, but we felt that Dr. Hale's sug~esti~n of a self-heating tin of soup, car ned In every life-boat, was an excellent one. Chemical hot-packs are, we learned, also carried in some of the boats. It was interesting to note the list of equipment included in the standard first-aid outfit supplied, but we would like to have seen a smelling-bottle or spirit of ammonia included, although, we have reason to believe, this is often added unofficially by the local organizers. The use of a tourniquet by laymen, even if they be experienced first-aiders, is open to question. Extensive F.A. Arrangements FoUowing our study of this little-known text-book (it is not available to the general public) we rang up Captain Summers, hon. secretary to the well-known Shoreham lifeboat, who kindly invited us to visit the life-boat the following day, an invitation, which we readily accepted. We were welcomed by Captain Summers, who introduced us to Mr. Harry Philcox, the mechanic and key-man of the crew of eight members. 'Harry' is well known throughout the district. We were enabled to inspect the first-aid arrangements, and were amazed to learn how much can be carried in so limited a space. Arrangements are now being made by the Institution to train two men in each crew in the art of first-aid, and we believe that these men are looking forward with keen anticipation to adding this valuable knowledge to their already wide range. We salute the Lifeboat Service.

F.C.R.

FIRST AID & NURSING, JULY/AUGUST 1956

Competitions

FIRST AID & NURSING, JULY/AUGUST 1956 4: Corps Nursing Officer Mrs. Thomas, S. R.N. (Duke of Lancaster's District).

, Dewar,' 'Perrott,' 'White Knox' and 'Dunbar-Nasmith ' Presentation by H.M. Queen Elizabeth the Queen Mother

A gigantic task confronted Mr. G. F.

Quilter, M.B.E., the St. John Ambulance Brigade secretary this year when he undertook to stage the Senior and Cadet Annual Competitions on the same day. They were held at the Central Hall, Westminster. Despite the fact that throughout the day 16 tests were being held simultaneously, he event passed off without a hitch, surely a tribute to the efficiency of Mr. Quilter and his willing staff. No less than 44 teams competed for the various awards, and the very narrow margins which separated some of the results testified to the keenness with which the struggle was fought. The tests were both varied and interesting: AMBULANCE TEAM TEST The members of the team are watching a circus performance when one of the clowns meets with an accident. Injuries: Fractured spine (cervical region), Colles' fracture (left), haemorrhage from nose, 'black eye'. NURSING TEAM TEST The team is staying at an hotel in readiness for a competition, when the leader is called to the lift, where she finds a porter trapped in the lift shaft. Injuries: Crush injuries of both lower limbs, toxic shock, laceration of thigh with bruising, fractures of both femurs. AMBULANCE CADET TEAM TEST The team is visting the home of a friend when an explosion (gas oven) takes place. The friend falls, pulling the table-cloth. Injuries: Burns of face (blistering), wound of left palm, Calles' fracture (left), shock. NURSING CADET TEAM TEST This team is also visiting a friend, whose young brother, wearing a swimming mask,

nose clip and flippers, stumbles, hits his head and falls. Injuries: Injury to head with wound and slight bleeding, irregulatity of underlying bone (no bone projecting), simple fracture of left leg. AMBULANCE INDIVIDUAL TESTS No.1 is called to attend to a boy who has fallen from a chair whilst reaching for a mineral water bottle. Injuries: Compound fracture of left arm near elbow, wound with haemorrhage, shock. Nos. 2 and 3 find a tailor with a needle embedded in the back of his hand, and as the result of a fall, has sustained a fractured skull with concussion. No.4 has to deal with a man who has attempted suicide. Injuries: Asphyxia (coal gas), incised wound front of left wrist. NURSING INDIVIDUAL TESTS No.1, under doctor's orders, has to take and chart pulse and respiration of a patient confined to bed with acute bronchitis, give a steam inhalation and a dose of medicine. Nos. 2 and 3 (Bedmaking). The patient is confined to bed with heart failure. No.4 has to take and chart T.P.R. and attend to evening toilet of patient confined to bed with paralysed upper limb. CADET AMBULANCE INDIVIDUAL TESTS No. 1 finds a small boy who has been pushed over by some bigger boys who have run away. Injuries: Fracture of right clavicle, shock. Nos. 2 and 3 hear a cry from the laboratory and find a boy who has been experimenting with chemicals. Injuries: Corrosive burns on left hand, wound of right hand with glass embedded, shock. (Left) The 'Victim' of the Cadet Nursing Girls from Boisover, Derby, Michael Hewitt of the Edgware and Mill Hill Division, being presented to H. M. the Queen Mother.

(Right)

The team of nurses from Machynlleth (Wales) giving first aid to a , victim' trapped in a lift.

No.4 hears a cry from a caravan, where he finds a Primus stove on fire and a man suffering from severe burns on face and left hand and slight burn on right hand. CADET NURSING INDTVIDUAL TESTS No. 1 has to describe the need for and method of keeping mouth moist, clean patient's teeth and apply spica to right thumb. Nos. 2 and 3 (Bedmaking). Change undersheet and drawsheet of occupied bed and count and chart pulse. No.4 is required to apply hot fomentation to leg and cold compress to head. The following judges had kindly given their services : TEAM TESTS Adult Ambulance : Dist. /Surgeon H. C. Stewart, M.D., M.R.C.P. (London District), Adult Nursing : Div. /Surgeon F. M. Hanna, F.R.C.S. (Dorset), Cadet Ambulance : Commr. D. J. Johnson, M .B.E., M.R.C.S.~ L.R.C.P. (Shropshire), Cadet Nursing: Area Commissioner 1. Mackenzie, M.B., B.S., M.R.C.S., L.R.C.P., (Derby), INDIVIDUAL TESTS Ambulance: Leader: Cty. /Surgeon J. T. Daly, M.B., Ch.B. (Worcester), 2 and J: Area Surgeon R. H. Kip ping, M.B., B.Ch. (Buckingham), 4: Area Surgeon D. F. B~.rrett, M.B., Ch.B., B.A.O. (W. R. YorkshLre), Nursing: Leader: Cty. Nursing Officer Miss M. Rennoldson, Matron (Essex), 2 and 3 : Cty. Nursing Officer Miss D. E. Brace, Matron (Berks.),

Cadet Ambulance : Leader: Div. Surgeon T. Scott-Reid, M.B.E., M.B.,. Ch. B. (Somerset), 2 and 3: DIV. Surgeon H. E. HughesDavies (Priory for Wales), 4 : Div. Surgeon J. C. Graham, M .R.C.S., L.R.C.P., D .T.H. (London District), Cadet Nursing : Leader: Dep. Cty. Nursing Officer Miss S. Griffiths, S.R.N. (Nottingham), 2 and 3 : Area Nursing Officer Miss S. P. White, Matro.n (London District), 4: Area NursIng Officer Mrs. Southern, S.R.N. (Surrey). UNIFORM Ambulance: Dist. Staff Officer S. J. Stillwell (London District), Corps Sgt. Major W. Burns (Kent). Nursing: Dist. Supt. Mrs : G. W. Lodge, O.B .E. CW. R. Yorkshire), Cty. Supt. Mrs. E. M . Courtney (Sussex). Cadet Ambulance : Cty. Staff Officer K H. M. Aldridge (Dorset), Cty. Cadet Officer J. C. Bell (Surrey). Cadet Nursing : Cty. Cadet Officer Mrs. Ettridge (Norfolk), Area Cadet Officer Miss A . R. North (London District). At 3.15 p.m. Her Majesty Queen Elizabeth the Queen Mother, who is Commandant-in-Chief Nursing Corps and Divisions, St. John Ambulance Brigade, arrived, and was received by Lord Wakehurst, Governor-General of Northern Ireland, who is Lord Prior of the Order of St. John. With the Lord Prior was Lieut. General Sir Otto Lund, KC.B., D.S.O., Kt. of St. John, Commissioner-in-Chief of the St. John Ambulance Brigade; the Countess Mountbatten of Burma, C.l., G.B.E., D.C.V.O., Dame Grand Cross of St. John, Superintendent-in-Chief of the St. John Ambulance Brigade; CounciLLor Patrick Stirling and Mrs. Stirling, Mayor and Mayoress of Westminster; Mrs. Grosvenor, C.B.E., Commander of St. John and others. After inspecting the guard of honour composed of the nurses and men of the competition teams and twelve South African St. John nurses, Her Majesty was conducted to the various halls where she witnessed a demonstration of each of the team tests which had been set that day. Major A. C. White Knox, O.B.E., M.C., M.B., Ch.B., Kt. of St. John, Surgeon-in-Chief of the St. John Ambulance Brigade gave a most lucid and instructive running commentary upon each test as it was staged. After an interval for tea the vast audience assembled in the great hall, where they were entertained to a short organ recital by Div. Superintendent F. E. Clifford, of London. The presentation ceremony was presided over by the Lord Prior, who was supported by Her Majesty the Queen Mother; Lieut. General Sir Henry Pownall, K.C.B., K.B.E., D.S.O., M.C., Kt. of St. John, Chancellor of the Order of St. John; General Sir Otto Lund; Countess Mountbatten; the Mayor and Mayoress of

Westminster; Major White Knox; the judges and others. As the chairman rose to welcome the Queen Mother a large bouquet was pre~ented to her by a small nursing cadet, WhICh she accepted in a most gracious manner. The Commissioner-in-Chief then rose to tha~k Her Majesty for so graciously consen.tIng to present the trophies, an act whIch was most deeply appreciated by both the Brig~de and the lay members of that vast audlence. He explained that it had been decided to hold the Senior and Cadet Competit!ons on the same day, an arrangeme!!t WhlCh he hoped would prove to be satIsfactory. He was pleased to assure Her Majesty that it h~d been most gratifying to learn from the Judges that the high standard of work by both seniors and cadets was being maintained. The chairman then asked the secretary to announce the results: ADULT AMBULANCE 1. British Railways, Camden (London) ... ... ... (winning the Dewar Shield and the Hingston Rose Bowl) 2. Dean and Chapter Colliery (Durham) ... '" ... (winning the Symons Eccles Cup) 3. Brighton Police (Sussex) (winning the Hong Kong Shield) 4. Cambridge City Police (Cambs.) (winning the Trimble Shield, the Ellis Cup and the CoplandGriffiths Cup) ... 5. Shrewsbury (Shropshire) 6. Cardiff City Fire Service (Wales) 7. Donisthorpe Colliery (Leicester) 8. Exeter City Police (Devon) 9. Northwich(Cheshire)... ... 10. S. Kirby Colliery (W.R. Yorks) 11. Banbury (Oxford) ADULT NURSING 1. Spalding (Lincoln) . .. . .. (winning the Perrott Shield and the Grosvenor Cup) ... 2. Atherton (Lanes.) (winning the Corbet Fletcher Cup and the Mountbatten Cup) 3. Chelmsford (Essex) ... (winning the Stewart Cup, the Chalmers Cup, the Ellis Cup and the Mountgarret Cup) 4. Sittingbourne (Kent) 5. MachynLleth (Wales) 6. Brixton (London) 7. Cosham (Hants.) (winning the Marguerite GoldingTrophy) 8. G.E.C. (Birmingham) ... 9. Hull Wilberforce (E.R. Yorks) 10. Clifton (Bristol) .. , 11. Scarborough (N.R. Yorks) CADET AMBULANCE 1. Fairbairn House (London) (winning the White Knox Cup, the Jarvis Cup and the Lowe Cup) 2. Cefn Cribbwr (Wales) ... (winning the Schooling Cup, the Barne Cup and the New Zealand Cup) 3. Gorleston and South town (Norfolk) (winnin~ the Pownall Cup)

340

323! 3181 317!

3161 3l4! 29312841 275 27U 2551 295t 283t 283

262t 258 255 229 334

327k

300t

4. Weymouth (Dorset) ... 5. Langwith Colliery (Derby) 6. Preston(Lancs.) ... 7. G. E. C. Witton (Birmingham) 8. Lancing and Sompting (Sussex) 9. Penzance(Cornwall) . . . ... 10. Fishburn Colliery and Welfare (Durham) ... ... ... 11. Skipton (W.R. Yorks)

295 284 261t 256t 250 248 243~

211

CADET NURSING 1. Stockton and Thornaby (N.R. Yorks.) "'''' ... 318} (winning the Dunbar-Nasmith Cup, the White Knox Individual Cup and the Tweedale Cup) 2. Treharris (Wales) ... ... 300~ (winning the Mountbatten Cup and the Cunard Cup) 298 3. Palmer's Green (London) (winning the Pownall Cup) ... 293 4. Wolverhampton (Staffs.) ... ... 283 5. Beccles (Suffolk) (winning the Bed-making Cup) 6. Bolsover (Derby) ... 279 (winning the Emdon Cup) 7. Hull Wilberforce (E.R. Yorks) ... . tied 266 7. Sherwell (Plymouth) I 9. Liverpool West Derby (Lanes.) 265 10. Maidstone(Kent) ... ... 260 11. Weymouth (Dorset) 259

Major White Knox, who had acted as referee, was asked to summarize the comments of the judges and to give his own impression of the work of the teams. He said that, in view of the splendid work he had seen that day, and the small margin which had separated the marks of some of the teams, it would be difficult to offer a tru.e assessment. He would, however, qULckly run through the tests and offer a few comments. He had been very favourably impressed with the approach of the boy cadets, but they must be more careful in their handling of sterile dressings. The work of the girl cadets had fascinated him, for it had been so thorough. Major White Knox dealt at length with the conflict of interests in the men's team test. In the case of a fractured spine it was most essential that the patient should not be moved, pointing out the serious consequences which could follow. The 'lift' test which the women had to deal with presented an unusual problem. Frankly, there appeared to be little that the team could do until the victim had been released from the lift-gate by the engineer. However, he pointed out that there were several preparations which might have been made whilst they were waiting. He summed up by saying that the standard of efficiency had been the best he had ever seen. Her Majesty's Speech The Commissioner-in-Chief then invited Her Majesty to present the trophies. She commenced by saying, , I am delighted to have had the opportunity of coming here today, and of seeing the work of the St. John Ambulance Brigade. This is a unique occasion, for I understand that it is the first time that the two competitions, senior and cadet, have been organized jointly. I feel that these competitions are of the greatest importance, for they serve as a yardstick by which the work of the

FIRST AID & NURSING, JULY/AUGUST 1956

Competitions Brigade is measured. I have watched four teams demonstrating this afternoon, and I was amazed at their efficiency. I was particularly impressed with the work of the cadets, upon whom th.e future of the Brigade depends. I realIze, however, that in many cases there wIll come a time ~~en you will have to decide b~tween remammg in the Brigade and other mAuences.-home ties for instance. I urge you to thmk very car~[ully before you make a decision. The Brigade needs your services. To all of you in the Brigade I would urge thIS great need. The need for your services is just as great in peacetime as in war. I am very ple~~ed to learn that during the past year recrUltlOg has been very satisfactory. Call~ for nursing service are always answered m the highest traditions of the Order, and there could be no greater satisfaction than t~at which follows the services you are rendermg to your fellow creatures.' The Lord Prior extended a cordial welcome to Her Majesty and to all those present. That day, he said, was no ordinary one, for it had been made an exciting one by the presence of Her Majesty the Queen Mother. Moreover, who had a better right than Her Majesty to be present, for was she not Commandant-in-Chief of the Nursing Corps and Divisions of the St. John Ambulance Brigade? In that capacity she had always shown the greatest interest in the work. 'This has been a memorable afternoon, Your Majesty,' he said 'and we shall all leave this hall stre~gthened by your gracious presence.' He was f~l1owed by Lady Mountbatten, who said that she felt that there was little which she could add to what had already been said. 'We do appreciate your presence here today, Your Majesty,' she went on, 'and the keen interest you co~ tinue to show in the movement. You WIll always receive our deepest affection.' The thanks of the Brigade were offered to the stewards, time-keepers, the Associated British Picture Corporation Ltd., the , patients' and' fakers' under the direction of Staff Officer George Craft, the secretary, Mr. Quilter, and especially to the judges who made the competitions possible.

South African Nurses Of the many uniforms to be seen from the Colonies, our attention was attracted to twelve we had never seen before. They were worn by a dozen South African St. John nurses who were visiting this country on a St. John pilgrimage. They told us that they formed a section of a party from South Africa which had been in England ten days, and would be re-joining their colleagues and returning to South Africa on the Stirling Castle, leaving England on 5th July, after a most interesting stay in this country. The competitions had been under the direction of Deputy Surgeon-in-ChiefM. M. Scott, M.R.C.S., L.R.C.P., and Chief Nursing Officer Miss Hamilton-Wedderburn, S.R.N., and the general arrangements had been carried out by Brigade Secretary G. F. Quilter, M.B.E. The singing of the National Anthem brought to a close this great occasion.

British Railways Regional Finals-Results .. EASTERN REGION Men: 1. Worksop Traffic 'A' 2. Yarmouth 'A' 3. King's Cross M.P. 4. March 5 Boston Engineers 6 Bishopsgate Goods 7. Sheffield Engineers Women: I. Mary1ebone Station 2. Doncaster 3. Cambridge

442 427

421 389~-

381

370 308 331

314 309

MIDLAl\1]) REGION

Men: 1. S1. Pancras Goods 2. Camden ... 3. Derby (Erect. Shop) 4. Kirkby Stephen E. 5. Crewe 6. Wolverton 7. Earlestown ' 8. London Road 9. Longsight (Loco.) Women: 1. Dublin No. 1 2. Earlestown 3. Manchester 4. Euston 'B' 5. Broad Street 6. Horwich ... 7. Dublin No.2 8. Euston 'A' 9. Derby 10. Somers Town 11. Wolverton 12. Stoke 13. Gorton ...

522t

434t 429 428

407i 375 364

360! 346! 329

318t 308t

SOUTHERN REGION Men: 1. Lancing Works No.1 2. Salisbury 3. Horsham No.1 4. Brighton No.1 ... 5. Exmouth Junction M.P. No.1 6. Southampton Docks S.M.E. No.1 7. Eastleigh Station 8. Meldon Quarry ... 9. Redhill ...

412i·

393i 384t

380i 373t 481 466

460 458t 449t 432

418 397 380 374!

3°st

306 253

WESTERN REGION 1. Bristol D.O.S .O.

2. Swindon 'B' 3. Shrewsbury Loco. 4. Ban bury 'A' 5. Taunton 6. Gloucester Central 7. Newport 'A' 8. Cardiff Docks No.1 9. Old Oak Common 'A' ...

Women: 1. Eastleigh Accounts 2. B.T.C. Police Women 3. Waterloo 4. Dorking 'A' 5. Dorking ' B' 6. Victoria .. . 7. Woking .. .

485 449 447t 445t 439t 421

394! 390 359t 441

396i· 395 386 365t

340t 3I8t

NORTH EASTERN REGION 1. Newcastle Central 2. Dewsbury 3. York C. & W. 4. Darlington North Road 5. Darlington Stores I 6. Middlesbrough 6. Hull 8. Brighouse 9. Harrogate 10. Halifax .. . 11. Leeds No.1

412

507 450 449

tied

377 369 360 350 342 330 317

'The Stanley' BrWsh Red Cross Society's Competitions Sussex is, indeed, a proud county these days, especially that portion ofitwhicblies within the boundaries of Brighton and Hove-but let's begin at the beginning. The Final First Aid and Nursing Competitions of the British Red Cross Society were held at the Friends' House, London, and were attended by a vast audience. For each team there was a team test, and in addition there were individual oral and practical tests, all of which proved most interesting.

THE TESTS Men Team Test: Andrew Haig, having fallen into the river from a bridge, hitting his chin, is dragged out by David Fife, who also sustains injuries in clambering down the bank . The team happens to be passing III a. car. Injuries: Andrew Haig: Fractured lower jaw (compound into mouth), grazed chin, unconscious, apparently drowned, lacerated right forearm, moderate haemorrhage, severe shock.

David Fife: Colles' fracture (simple, left), severely lacerated palm (left), moderate haemorrhage, moderate shock. This was set and judged by WingCommander W. Davies, R.A.F. and Surgeon-Commander F. B. B. Weston,

R.N. Officer (Individual): Give first aid for simple fracture of ribs, right side. Give first aid for incised wounds of ball of thumb, right side, with moderate haemorrhage. Nos. 1 and 2 (Dual): Give first aid for simple fracture of right femur, middle third (no splints available). No.1 (Individual): A night watchman is discovered unconscious in his hut with a brazier. Givc first aid. No. 2 (Individual): Give first aid for wound of face just below right eye with retained glass. Nos. 3 and 4 (Dual): Give first aid for fractured pelvis and abrasions of right palm.

FIRST AID & NURSING, JULY/AUGUST 1956

No. 3 (Individual): Give first aid for fractured scapula, right side. No. 4 (Individual): Give first aid for lacerated wound of right ear (moderate haemorrhage), using roller bandage to secure dressing. These were set and judged by SurgeonCommander C. L. T. McClintock, R.N. Oral questions from the Official Text Book were set and judged by Major D. L. Scott, R .A.M.C.

Women Team Test: Crossing a farm, they hear cries for help, and find a farm girl, who has been knocked down by a large barrow containing a heavy sack of potatoes, taking her with it. It also knocks over a second farm girl who is carrying a bill-hook. Injuries: Queenie Trotter: Simple fracture, right clavicle, s~verely .grazed face, right side, lacerated nght shin, moderate haemorrhage~ moderate shock. Grace Gander: Fractured right ribs, haemoptysis, incised wound, left forearm, with severe haemorrhage, severe shock. This was set and judged by G roupCaptain J. Parry-Evans and Lieut.-Colonel W. Windsor, R.A.M.C. (First Aid section) and Miss J. Addison (Matron of Guy's Hospital) and Miss M. ~ill (Principal Sister Tutor, London HospItal) (Nurstng section). Officer (First Aid test): Give first aid for simple fracture of ribs, right side. Give first aid for incised wound of ball of thumb, right side, with moderate haemorrhage. Officer (Nursing test): Prepare the requirements for the administration of oxygen. . .. . Prepare to give a hypodermIc llljectlOn of 5 minims of this fluid. Nos. 1 and 2 (Nursing test): Remake the bed of this patient who is unconscious. No.1 (Nursing test): Prepare trolley for a simple dressing. No. 2 (Nursing test) : Prepare the requirements for a moist inhalation. Nos. 3 and 4 (Nursing test): Change t~e undersheet of this patient who has chrome heart disease. No. 3 (Nursing test): Prepare the requirements for last offices. . No.4 (Nursing test): Apply a medical fomentation to the left knee. The tests for women competitors were set and judged by W . McKim H. McCull~gh Esq., D.S.O., M.C., T.D., F.R.C.S. (Fmt Aid), Wing-Commander W. B. Tho r.burn, R .A.F. (First Aid), Col. G. W. Fnzelle, T.D., M.D. (First Aid), Mi~sD. L..HoJland, Sister Tutor, Guy 's HospItal, MISS D. A. Lane and Miss E. Perrin-Brown (Nursmg). The uniforms were judged by Mrs. y. Crane County Director, Shropshire Branch, B.R.C.S., and M~ss V,. A. Norton, County Director, Denblghshlre Branch, B.R.C.S. (Women) and Major-General L. A. Hawes, c.B.E., D.S.O., M.C., M.A., Controller, Home Department, B.R.C.S ., and Lieut.-Colonel J. H. A. Dean, County Director, Worcestershire Branch, B.R.C.S. (Men). . After an interval for tea the vast audience returned to the main hall, whcre a transformation had taken place on the platform. The scenery for the Women's Team T~st had been removed, and in its place chaIrs had been arranged around ~ large ta~le bearing the magnificent trophIes for whIch

Sussex-The winners. thirteen teams, the cream of the British Red Cross Competition world, had striven that day. Occupying the presidential chair was the Countess of Limerick, G.B.E., LL.D., Vice-Chairman of the Council, who was supported by Her Royal Highness the Princess Royal, c.r., G.C.V.O., G.B.~., R.R.C., with Mrs. Cuthbert (LadY-lllWaiting); Mrs. Anne M. Bryans, C.B.E., Deputy Chairman; Major-General L. A. Hawes, C.B.E., D.S.O., M.C., M .A., Controller, Home Department; Air-Commodore H. A. Hewat, C.B.E., M.B., Ch.B., D.T.M. & B., Medical Adviser;. Miss M.!3-. Craven, R.R.C., Matron-in-Chief; MISS Naylor-Smith, Assistant Secretary; Mrs. Hetherington, Staff Officer, Horne I?epa~t ment and the judges. We also notIce~ 10 the hall Air-Marshal Sir James KIrkpatrick, Director-General R.~ . F. Medi~al Services; Lieut.-General SIr Frede~lck Harris Director-General, Army MedIcal Servic~s' Surgeon Vice-Admiral Sir Alexander 'Ingleby - Mackenzie, Medic~1 Director-General of the Royal Navy; An Commandant Dame Roberta Whyte, Matron-in-Chief, P.M.R.A., F.N.S.; Brigadier Dame Helen Gillespie, Director and Matron-in-Chief, Q.A.R.A.N.C. and ot~ers. Lady Limerick opened t~e proceedmgs by expressing the appreciatIOn of all present at the honour conferred upon them by Her Royal Highness, who had so graciously consented to atten~ tI:~re and present the trophies. Before lDvItLDg her to do so, however, she felt certain that they would like to hear the comments of the judges, and she asked Miss Addison 1,0 comment upon the part of the Women s Team Test which she had judged.

Marked Improvement . Miss ' Addison, speaklllg <?n b~half of herself and her colleague, MISS HIli, congratulated the winners upon their succ~ss, stating that she had noted a marked I.mprovement in the work since her last VI~It a year ago. Altogether, the leadership was excellent, but it was vari~d. She felt that in many cases too much time had been occupied in the first aid part of the test, !"or it had been hoped that more of the nursmg would have been seen. Some of the mem bers of the teams had been somewhat flustered, and had given more wo~~ than they had taken away. The bedmakmg had been good, but she a~vised them always to use the proper matenal for the purpose for which it had been prOVIded, glV.lIlg as an example the draw shee~. Handlmg of ~he patient and also takmg and recordmg T.P.R. had been good. She had noted that in some cases they had not been too

The Warwickshire team in action. familiar with the use of the roller bandage for first aid purposes. Speed must be borne in mind. Miss Addison concluded by saying that the nursing profession owed so much to the British Red Cross Society, for they fully appreciated the sacrifices which are so often made in order to assist in the hospitals. She hoped that the voluntary spirit would always be kept alive. Difficult Cases Treated Best Miss Addison was followed by LieutColonel Windsor, who, with GroupCaptain Parry Evans, had judged the first aid part of the Women's Team Test. He said that it was always a pleasure to accept the invitation to judge these tests for he often met the B.R.C.S. members in the hospitals. He had, on some ~revious occasions, criticized the leadershIp,. but that day it had been good. He remmded them that they had had two distinct cases to deal with, one more difficult than the other. Curiously enough, most of the teams had treated the difficult case much better than the clavicle, which was really the ea~ier of the two. Treatment had not been umform. Speaking generally, the difficult c~ses had been dealt with better than the easier on~s. He believed there was a reason for thiS. As they progressed in their work there was a tendency to forget what they had learned earlier, concentrating upon the latter-and more difficult-work. One or two teams did not enquire whether or not haemorrhage had started again, and one team mIssed the clavicle altogether. This was very naughty (laughter). Altogether he had been very satisfied with the work. . The Men's Team Test had been Judged by Wing-Commander Davies and. Surgeon Commander Weston, and Wmg-Commander Davies acted as spokesman for them both. He thanked the B.R.~ . S. for making their task so easy by producIr:g such proficient teams . 'What an ordeal It m~st be,' he said, referring to the competmg teams, 'to come <?n the scene to eI?act a drama without scnpt or even a preview of the task before them.' He had. every sympathy for them, for he recalled hiS o,:,n early examination .days. Few, he said, would do in those cIrcumstances what they would do in an actual ca.se. They V:'0ul.d then assess the complete sl~u.atlOn, which IS not always done in competItIOn on account of nerves. We know that they would do this in real life, and we therefore make every allowance for nerves. He c.ould r:ot speak too highly of the manner III whlc~ the patients had been handled. If .ever It were his misfortune to meet WIth an accident and he were treated by B.R,C.S.

FIRST AID & NURSING, JULY/AUGUST 1956

FIRST AID & NURSING, JULY/AUGUST 1956 9

Competitions members, he would be very glad that such an organization existed. H~ conclu~ed by thanking his hearers for their attentlon. At this point the results were announced by Major-General Hawes: RESULTS-WOMEN 1. Sussex 114 ... ... (winning the Stanley Shield) 2. East Lancashire 8 ... .,. (winning the Hetherington Cup for Nursing) 3. Worcestershire 44 4. N. Riding, Yorkshire 24 5. Angus 6. Kent 36 7. South Lincolnshire 2 MEN ]. Sussex ] 3 (winning the Stanley . Shield) tied 1. County of London 71 (winning the Stanley Shield) 3. N. Riding, Yorkshire 5 4. Warwickshire 21 5. Bristol 11 6. Kincardineshire 5

765t 737 725-} 716 696 683 639

707

669 660 650 617

Other awards: Evelyn Wren Cup (Officer with highest marks) Miss Ayres, Worcester 44, Georgina E. Morgan Bowl (Member with highest marks) Joint win by Miss D. Last, Sussex 77, and Mrs. Yetta Rose, Sussex 77. Margaret Gordon Harker Cup (Team Leader with highest marks) Mr. Gordon Slade, Sussex 13. Lieut-Colonel R. M. West Cup (Member with highest marks) Mr. Jack Drewett, Warwickshire 21. In response to the invitation of Lady Limerick, Her Royal Highness addressed the assembly. She said: 'Last Wednesday Her Majesty the Queen Mother visited our Headquarters and graciously spoke of the value of the work being done by the Society, the magnitude of the task still awaiting us, and the part which the new scheme will play in helping us to surmount it. , In my visits I, too, have seen how much is being done and how much there is still to do. I have seen, also, the remarkable success which is already attending the new scheme, where the task of introducing it has been tackled with imagination, enthusiasm and sustained energy. In areas where the Society previously was not represented we have now flourishing groups of Members undertaking valuable work, hitherto left undone for lack of helpers. Million Members for New Scheme , For the new scheme we are looking for a million members, and I want every one of you, whatever your position in the Society, to play your part in achieving this target, which I am satisfied is well within our power. 'I would like to make one other point. As you may have heard, the Duke of Edinburgh's Award Scheme is about to be launched. This most imaginative project is designed to meet the increasing need, under modem conditions, to provide incentives and opportunities for young people to achieve a balanced development of their character and physique, in preparation for citizenship.

, Initially the scheme will be operated on a limited scale to make sure that it is based upon a firm foundation. When this is assured, it will be opened to boys of appropriate age groups all over the Kingdom. Under the scheme boys will be awarded badges and certificates on attaining skill in rescue and publ ic service training, expedition, pursuits and fitness, of standards appropriate to their ages. 'The Society is privileged to take a special part in the scheme. Not only will boys in selected areas be able to undertake the training and tests, but we shall be asked to give instruction in First Aid and rescue training to other youth organizations. 'Initially this will not be a very great task, but when the experimental period is over and the scheme is extended to cover all the boys in the Kingdom, the demand for instructors will be very great. Importance of Instructors , I want, therefore, to impress upon you the importance, while there is still time, of training more, and yet more, instructors. We should aim at making every V.A.D. member, man or woman, who has the personality and the neces.sary proficiency in first aid, into an instructor. Only thus shall we be able to face the future with confidence. 'And now I would like to say how glad T am to be present once again at the Stanley Shield Competition and give away the prizes. , I know full well how much energy and time have been devoted to training, not only by the teams present here today, but also by the hundreds of members who took part in earlier rounds. 'To those not fortunate enough to win I would say you will be able, as the result of your efforts, to deal efficiently with any accident you may meet. 'That is why we belong to the Society and why we are all here today.' After Her Royal Highness had graciously presented the trophies, Lady Limerick, in replying to the Royal speech, said, ' How fortunate we are in having at the head of our Commonwealth a Royal Family which takes so great a practical interest in the work of saving life and alleviating pain. The visit of the Queen Mother recently to the Headquarters of the B.R.C.S. was an inspiration to all, and will be long remembered.' She then went on to speak of that day's event. It was unfortunate that Lord Woolton, another Vice-Chairman of the Council, had been prevented from attending that day, but she felt certain that Lady Woolton, who was President of the Sussex Branch, would be proud of the honour which had come to that county that day. Turning to the Princess Royal she said: 'This may be a formal vote of thanks, Your Royal Highness, but this is a family gathering, and we very much appreciate the very personal interest you take in the Society. You have "worked your passage" (the Princess Royal ' has actually been through the courses and holds the Society's certificates) and with your academic knowledge you are able to appreciate the tasks set us.' Lady Limerick expressed their gratitude to the medical and nursing services, to whom they owed so much. They not only helped in training the members but were always willing to sacrifice their time and

give of their skill to come and judge these competitions. They were also gratefu 1 to the Casualties Union, the Essex and City of London Branches of the B.R.C.S., who had provided the' patients '- and what ghastly sights some of them had been !-and makeup artists. She thanked the Associated British Picture Corporation Ltd., who had so generously provided and erected the scenery and stage settings for these tragedies, and the many helpers, too numerous to mention individually, who had worked behind the scenes. Turning to Her Royal Highness she said: 'To you, Ma'm, we owe a deep debt of gratitude for your encouraging words and the gracious manner in which you have presented the trophies.' The event concluded with the singing of the National Anthem. Sussex Thanksgiving Service Since writing the above report we have learned that in order to give.cxpression to their gratitude and appreciation of the honour brought to the Division by the Brighton and Hove teams, a Thanksgiving Service was held a few days afterwards in St. Mary's Church, followed by a reception at Church House, presided over by Miss K. Ward, S.R.N., M.C.S.P., County Director (Sussex). This was largely attended by the friends and relatives of the members of the successful teams. Incidentally, we learn that this success constitutes a record in being the first time in the history of the Society that both Stanley Shields have been won by teams from the same county.

British Transport Commission (Railways and Docks) & B.T.C. PoliceNational First Aid Competitions What a long title, but by no means inconsistent with the importance of the event. It was held at the Central Hall, Westminster, and attracted a large a nd enthusiastic audience from all sections of the British Transport Commission. No less than 26 teams, both men and women, had entered, and four tests were taking place simultaneously throughout the day. THE TESTS Team Test for Railway Men: Walking through a wood the team come across a sportsman who has evidently shot himself accidentally, and fallen on some broken glass. Injuries: Gash on left side of face, with glass embedded, simple fracture of left clavicle, simple fracture of right ankle, bruising at level of spleen, causing internal haemorrhage. The test was set and judged by Dr. Ian Mackenzie, of Derby. Team Test for Railway Women and B.T.C. Police: The team witness a cyclist knocked down by a heavy case falling from a lorry. Injuries: Contused swelling of left forehead with concussion, lacerated wound of left upper arm, Colles' fracture, right, sprained ankle. The test was set and judged by Dr. W. N. Booth, of Harlow. Dual Practical Tests for Railway Men: Nos. 1 and 2 find a man lying on the

ground in a hut with his clothes on fire. A Primus stove has exploded. Injuries: Bums on face and hands wound on face with F.B. (metal) embedded: Nos. 3 and 4 find a woman lying on the floor. She has obviously been ironing. Injuries: Asphyxia (frayed cable), burns on right hand. These tests were set and judged by Drs. T. E. Wood, of Plymouth, and J. T. Daly, of Binningham. Dual Practical Tests for Railway Women and B.T.C. Police: Nos. ] and 2 find a window cleaner who has fallen from his ladder across a low wall. Injuries: Internal haemorrhage due to torn spleen, simple fracture at left elbow. Nos. 3 and 4 find an elderly man lying on his back with some timber across his legs. Injuries: Compound fracture of left tibia and fibula, toxic shock. These tests were set and judged by Drs. C. H. Drake, of Gloucester and R. Cubitt, of Sleaford. Mr. Horace F. Parshall, T.D., M.A. (Oxon.), Director-General of the St. John Ambulance Association, occupied the chair at the presentation ceremony, and was supported by the Rt. Hon. Harold Watkinson, M.P. (Minister of Transport and Civil Aviation) and the judges. In welcoming the Minister he rerrunded his hearers that first aid commenced to be taught in British Railways long before they became part of the British Transport Commission, and the competitions they had witnessed that day were regarded as an index to the Grand Prior's Competitions to be held in November. Of the many who had contributed to the success of the event that day he mentioned particularly the British Picture Corporation Ltd., who had once again so generously supplied and erected the scenery, the stewards and time-keepers, the voluntary 'patients' and make-up artists who spent so much of their private time in training, and particularly those hard-worked men of science, the judges, who were always so ready and wiJJing to give of their time and skill in this grand cause. Dr. Mackenzie, in response to an invitation from the chair, offered some comments upon the work he had seen that day. In all cases except three the examination of the patient had been carried out in a very cursory manner. They did not listen to the patient's story or attempt to obtain a history of the case. Haemorrhage must be attended to at once. In one case six minutes elapsed before any attempt was made to control haemorrhage. He was surprised at the careless treatment of equipment. He saw antiseptic cream trodden underfoot. In some cases the patient had received equally rough treatment. However, although he had been severe in his criticizm, he had to admit that the standard had been good. Dr. Booth commenced by saying that he had to endorse what Dr. Mackenzie had said about the control of haemorrhage. Referring to the taking of pulse, few, he said, had taken this in the correct manner. Moreover, they must make a complete examination of the patient before they could treat successfully. Some had missed the ankle injury altogether, otherwise the work had been good. In the oral tests they

had shown a thorough knowledge of the text-book. He concluded by paying tribute t~ the very gentle touch by the' girl from EJre.' Mr. George Craft, the competition secretary, then announced the results: RAILWAY MEN 1. Bristol D.O.S .O. (winning the Challeng~' Shiel'd) 2. Lancing No . 1 . . . ... (winning the Corbet Fletcher Cup) 3. St. Pancras Goods 4. Swindon 'B' '" 5. Worksop Traffic 'A' 6. Camden ... .. . 7. Newcastle Central 8. Salisbury M.P. ... 9. Yarmouth 'A' ... 10. Dewsbury Central 1] . Motherwell 12. Lots Road 13. Bridgeton RAILWAY WOMEN 1. Baker Street (winning the Burrows Rose Bowl) 2. Dublin 3. Newton Abbot 4. Eastleigh Accounts 5. Hull

525~

5]8 5011 500} 483t 4811 471 ! 454t 449t 447± 446 427 416l 482 480t 453 451t 450

6. Glasgow.. . ... 7. Marylebone Station

425t 415

BRITISH TRANSPORT COMMISSION POLICE 1. Liverpool Street .. . ... 500~. (winning the Sir Bertram Ford Challenge Shield) 2. Dover Marine ... 457} (wi nning the Chiefs of Police Cup) 3. Darlington 457 4. Edinburgh 450 ~. 5. Liverpool 415 ~" 6. Nottingham ... ... ... 405 ~ In presenting the trophies, Mr. Watkinson expressed the delight he felt in being there that day, but what impressed him more than anything else was the fact that all this was voluntary. He believed that one of the great strongpoints of this country was the desire to help others, and he was proud of the manner in which the railways contributed to this spirit. He congratulated all those who had managed to reach this stage, and hoped that they would note the comments made by the judges. He hoped that the Grand Prior's Trophy would come to British Transport in November. In response to the thanks of Mr. Parshall the Minister said, ' Good luck to you all: and keep up the good work .'

Ministry of Supply Finals Is there such a thing as a double hattrick? If so, then the Storage Department, Elstow, Women's team have achieved this phenomenal success, having won the Women's Challenge Trophy, presented by the St. John Ambulance Association, for the sixth year in succession-in fact , every year since the Women's competitions have been held. On the other hand, the Men's Challenge Trophy, also presented by the Association, has been won by a different team on each of the seven years the Men's competitions have been held. The competitions for these Challenge Trophies were held at the Central Hall, Westminster. THE TESTS Men's Team Test, set and judged by Dr. F. H. Taylor, O.B.E., of Streatham. The team happens to overhear a 'phone call for help, and, upon enquiry, learn that a man has fallen from a tree, and they find him lying in pain. Injuries: Compound fracture of left leg with bone protruding, dislocated left shoulder, bruising of hip and pelvis. Women's Team Test, set and judged by Dr. E. J. Selby, O.B.E., of Ealing. The team, walking in the country, finds a cyclist lying entangled in his machine. Injuries: Slight concussion, but conscious, bruise on forehead, wound on left arm, with severe haemorrhage, compound fracture of left leg, closed fracture of right leg. Men's Dual Tests, set and judged by Dr. Lancelot K. Wills, of Neasden. Nos. 1 and 4 are called to a man who has evidently been knocked down by a car which has failed to stop.

Injuries: Contusion on head with consimple fracture near left elbow, slffiple fractures 7th, 8th and 9th left ribs beneath abrasion of skin. Nos. 2 and 3 are called to attend to a man who appears to have fallen whilst working in his garden. Injuries: Severe wound of left forearm with arterial haemorrhage, bleeding from right side of nose, Potts' fracture, left, toxic shock. c~ssion,

Women's Dual Tests, set and judged by Dr. A. M. Pollock, of Tunbridge Wells. Nos. 1 and 4 are calling upon a friend, who informs them that her mother has slipped and knocked herself against the kerb surrounding the fireplace . Injuries : Compound fracture of left forearm, strained left calf muscle, shock. Nos. 2 and 3 have to deal with a man who is brought into their first aid station at a fete, having stumbled over some article on to his right hand . Injuries: Fracture of right clavicle, wound in right palm, graze on forehead. The competitions over, the platform was prepared for the presentation ceremony, which was presided over by Horace F. Parshall, Esq., T.D., M.A . (Oxon.), Director-General of the St. John Ambulance Association. He was supported by the Rt. Hon. Reginald Maudling, M.P., Minister of Supply, and the judges. Mr. Pr.lTShall opened the proceedings by saying that it was an honour to be able to welcome the Minister of Supply, who had kindly consented to present the trophies to the winning teams. It was an immense encouragement to them for Mr. Maudling to find time to spare from his very heavy duties to come there that day. He was also pleased to see representatives from

FIRST AID &

URSING, JULY/AUGUST 1956

FIRST AID & NURSING, JULY/AUGUST 1956 11

Competitions other ministries, and from the Brigade. He went on to emphasize the value of competitions which lies in what we learn from them. Once again he was pleased to extend the thanks of the organizers to all those who had contributed to the success of the event, especially the Associated British Picture Corporation Ltd. , the stewards and oth.ers. There were, also, those voluntary. artIsts, the' patients' and' fakers' who., In conjunction with the scenery, contnbuted to the realism of the tests. Lastly, they could never thank the judges sufficiently, for it was their knowledge and skill which made these competitions possible. He asked Dr. Taylor if he would comment upon the Men's team test. Haemorrhage The test, said Dr. Taylor, was reasonably difficult, and it would be noted that a change of routine had been made by making it unnecessary for the team to call the ambulance as that had already been done. One or two had failed to take advantage of this. Others did not wait to hear what the man in the 'phone kiosk had to say. He drew attention to the special treatment of fractured leg when rough ground had to be traversed, a matter which had been overlooked by some. Dr. Wills, he said, agreed with him that treatment of haemorrhage was not always commenced immediately. However, on the whole, the cases had been handled well. Dr. Selby congratulated the Women's teams upon their work, especially as he had noted that there were some new teams competing this year. He, also, emphasized the importance of immediate treatment for haemorrhage. When the patient complains of pain support of the part is invariably indicated. Avoid' snap' diagnoses, he warned. If practitioners were to depend upon 'snap' diagnoses he feared that they would very soon find themselves in the law courts. Finally, they must try to realize that they are dealing with human beings and remember those few kindly words of encouragement. The announcement of the results followed:

MEN 1. R.R.E., Defford

295

(winning the Challenge Trophy)

2. C.D.E.E., Porton 3. R.O .F., L1anishen 4. N.G.T.E., Pystock 5. R.A.E., Farnborough

283 215t

265i

255 253 7. R.O.F., Bishopton 250 8. R.O.F., Fazakerley 244 9. R .O.F., Chorley 236 10. R.O.F., Birtley .. , 220t 11. R.O.F., Nottingham 142~ Best Pairs Cup: Nos. 1 and 4, R.O.F., L1anishen.

6. S.D., Elstow

WOMEN 1. S.D., Elstow (winning tbe Challenge Trophy) 2. H.Q., St. Giles' Court 3. R.A.U., Hereford 4. R.A.E., Farnborough 5. R.O.F., Blackburn 6. R.O.F., Chorley... 7. R.O.F., Nottingham

323t 321 272t 257t 256t

255~·

198

Winning men's team (from R.R.E. Defford) re- Best Individual Pairs (S. D., Elstow, Ladies, R. O. F., LJanishen, Men). ceiving trophy from Minister of Supply, Rt. Hon. Reginald Maudling, P.c., M.P. ever since. Last year 15,000 patients had 8. R.O.F., Bishopton 184t been treated by their members. Best Pairs Cup: Nos. 1 and 4, S.D., Mr. Parshall said that the St. John Elstow. Ambulance Association had always worked In accepting the invitation from the chair well with the Ministry of Supply Ambulance to present the awards, Mr. Maudling conCentre, and it had been a great encouragegratulated the winners, but he felt bound to ment to them to have the Minister with refer to the fantastic success of the Elstow them that day. He would like to say S.D. Women's team. He wished them the , Thank you.' best of luck at the Grand Prior's ComThe competition had once again been petitions in November. He felt they were in the capable hands of the Competition all grateful to Mr. Parshall for the manner Secretary, St. John Ambulance Associain which he directed the affairs of the tion, Mr. George Craft. S.J.A.A. The Association was always ready to help the movement, and was responsible for the magnificent trophies Footnote they saw before them on the table. We would like to draw special attention He would like to take the opportunity of to Dr. Selby's warning against 'snap' thanking the president, officers and memdiagnoses, with which we heartily agree. bers of the Ministry of Supply Ambulance Diagnosis must be studied more thoroughly. Centre, and especially their . Medical This is a point which Major White Knox, Officer and Training Officer, and he wished Principal Medical Officer to the St. John them every success. The Centre was Ambulance Association, is constantly p.mphasizing. established in 1951 and had progressed

From a seat in the audience Some Random ( and Provocative) Comments on the Competitions Stanley Shields , Written messages are safer than verbal' -vide text book-especially via unknown bystanders. Some did not turn the mattress. Palms down, please, nurses, in tucking in, and keep together. Why not use the bed-blocks? They were close handy. Why not combine Schafer and H.N.? There was nothing to contra-indicate. Preparing and blanketing stretcher is a two-handed job. We would like to see' Load ambulance.' Fancy walking a patient with fractured ribs and haemoptysis, Use of hand-lifts often forgotten. 'Do the pupils react?' Where's your torch ? The fall of that kidney basin was enough to awaken the dead. We must again insist upon a study of body mechanics. Work would be made much easier. Successful A.R. depends upon a thorough knowledge of natural respiration mechanics. Did she forget where she had left her cuffs? Another team all lost their caps. We only saw one team 'promote circulation' correctly according to the teachings of the R.L.S.S. It is not often the teapot is brought as well. It was quite a tea-party.

We expected every minute to see the bed over the edge of the platform. We saw an unusual method of making a , pack " but must admit that it has certain advantages. Don't screw up a blanket- fold it. B.T.C. (Ratlways and Docks) and B.T.C. Police Some hesitation in smothering the flames. How manv asked' Nature of Ground' and' Distance' ? , Is your lorry switched off?' Sensible question. Can you palpate for fractured spine over clothing? 'The police are coming at their usual speed,'-and from a police officer! Was it necessary to finger that laceration? Empty vessels are often treated with scant respect. If they are intended to be full, let them be full. She searched his pockets first ! Bystanders should not' blanket stretcher' except under detailed instructions. They are not supposed to know how. How easily she moved that 'heavy packing case.' The whole test was marked by anxiety about the time. 'Covering patient' whilst performing A,R. seems to present difficulties. Signals from the time-keepers' tables are often distracting.

We like to see that talk with the team by the judge afterwards. The leader from Dublin was really scared when it was suggested that the bike be moved. 'I am comparing the limb with the other side.' She was doing nothing of the sort. What! A Bobby without a watch! 'I don't know him from Adam.' We don't think he was Adam. , That ambulance is a damned long time coming! ' 'Do you smoke? Sorry, I don't myself, so lean 't offer you a fag.' Ministry of Supply Commenced collecting material before knowing what might be required. That pressure wouldn 't have stopped a fly's artery, One tea~ was obviously a novice one, but they dId very well. Overlooked the fact that it was TOXIC shock. Did she expect to reduce that clavicle from that position? You must stand behind the patient. How easily that haemorrhage is often controlled! Judges should be more strict. , Anyone got a pencil?' Every member should carry one. Removal of clothing needs practice. Don't push the poor devil over. There is a correct technique for turning. What's happening to that haemorrhage whilst you're preparing the dressing? Tea always seems to be ready and waiting to be called for ! , Any pain?' 'No.' What,! with a dislocated shoulder ! Don't put words into the patient's mouth. , Dewar' and ' Perrott ' What a pity the ring barrier could not have been removed. Test was concealed from spectators. An interesting problem, but life comes before the show. Is not crush syndrome usually concealed until after release of patient? Surely the hotel would be warmed, in which case blankets and hot water bottles would be contra-indicated. The speed with which the engineer released the lift was miraculous. It was obious that some of the cadets had not had much experience with 'faked' patients. We are pleased to see cadets being trained as patients. The cadets were quick to cover burns and wounds. Stretcher work by cadets was usually excellent. , Is this material sterile ?' What! after the way he had been fingering it ! Surely a F.B. protruding two inches could be removed. That 'cup of tea' must have been empty held at that angle. , Get some screens.' Where from? , Nature of ground?' This should have been asked before splinting leg (See special instructions in text-book). , I have made the patient comfortable.' We didn't notice it ! There was a teeny weeny bit too much prompting by the judge. That middle seam! (bed-making). She should have checked the tray before commenci ng.

* First-Aider~s Crossword No. 24 Compiled by w. A. Potter

ACROSS 1. Comparatively of slender physique (2,4,2, 1,4) 9. Unwilling worker in the end ... (9) 10. Bovine nonsense ? (5) 11. Baby does this at about 8 months (4,2) ... 12. Fingers crushed and re-formed (7) 15. Intravenous infusion (4) 16. Cures from shale (5) 17. Count the feet .. . (4) 19. Should be dressed ? (4) 20. Hard wood, but can be broken by one (5) 21. Don't disturb, first-aider! (4) (7) 24. An insoluble difficulty 26. A snore for sanity (6) 29. Near end of alimentary and (5) Panama Canals 30, Intolerant on the wards (2,7) 31. Look for substances important (5,8) in nutrition ... ' "

DOWN 2. Indecision of schizophrenia 3. Embarrassing muscular spasm 4. Sight of myopic 5. X-ray evidence of immovable joint in the skull 6. Rank joke about met a l 7. By which the surgeon heals g, ew return of sebaceous cyst 9. The Doctor in the house ? 13 . Goitrous neck hides berry 14. Urge-often opposed to 21 18. Sign of toxic shock or fear 22. Acid for burns from tin can 23. The rambler's rash? ... 25. Flush of tuberculosis . .. 27. Bag for cold application 28. Peas in church ...

(5,4) (6) (4) (6,4) (6) (5) (3)

(8) (10) (8) (4,5) (6) (6) (5) (3) (4)

SOLUTION TO CROSSWORD NO. 23 ACROSS 1, Endocrine system; 9, Adrenal; 10, Roasted; 11, One; 12, Ego; 13, Dynamic; 15, Oats; 16, Congenital; 19, Strychnine; 20, Hand; 22, Untruth; 25, Lip; 26, Emu; 27, One slip; 28, Cheat Ie ; 29. Risus sardonicus.

DOWN 2, Dura mater; 3, Cancer; 4, Igloo; 5, Erred; 6, Yearning; 7, Totem; 8, Medical advice; 9, Aqueous humour; 14, Snail; 17, Traumatic; 18, Scruples; 21, Spleen; 23, Tress; 24, Hepta; 25, Lucid,

FIRST AID & NURSING, JULY/AUGUST 1956

FIRST AID & NURSING, JULY/AUGUST 1956 13

Beader~

Queries Answered by Dr. A. D. Belilios R. D. J. (Epping) writes:Regarding the treatment of stings with plants and animals, what is there in the wet 'blue bag' which is of value, and that we are advised to apply? Answer I got into touch with Reckitt & Colman Ltd., in regard to your question and am grateful to them for their reply, in which they tell me the blue bag is essentially a mixture of ultramarine and sodium bicarbonate and the suggestion is that the latter neutralizes the formic acid which is usually regarded as the cause of the irritation resulting from these stings.

E. W. C. (Rickmansworth) writes:As a keen first-aider and a member of the Civil Defence ambulance section, I regularly read your articles in FIrst Aid & Nursing. In your articles covering' Unconsciousness' in the May/June, 1955, issue you advise giving sugar as part of the treatment for 'Insulin Overdose.' In the Civil Defence first-aid manual, after giving the signs and symptoms of 'Diabetic Coma' (pages 189-190), the treatment includes 'in the event of sudden confusion or faintness please give two tablespoonsful of sugar in water ... ' These two seem to contradict each other, to me, and I would be very grateful to you if you could clarify things for me. Answer In the early stages, it is not always so easy to distinguish between Insulin overdose and Diabetic Coma. Moreover, the latter is not entirely caused by too much sugar in the blood; other toxic substances play an important part. It is therefore correct to give sugar in both cases; any excess in diabetic coma will soon be counteracted by the insuli n given by the doctor.

M. C. M. (Leicester) writes:A brain tumour is mentioned in the S.J.A.A. book as a cause of uncon-

sciousness. Although I appreciate that this is outside the scope of first aid, I should be very grateful for some information on this subject. Answer This is a growth in the brain. It causes severe headaches associated with vomiting, giddiness and disturbances of sight. Other symptoms and signs depend on the area of the brain affected, e.g. paralysis, fits, impaired hearing, etc. Unconsciousness is not uncommon particularly if bleeding occurs with the tumour.

stand why there was no indigestion. Would you please explain the possible causes of her condition. Answer A duodenal ulcer is the most likely cause and sometimes these (as also gastric) ulcers arise silently neither causing pain or indigestion. A complication such as bleeding which is what your patient probably had may sometimes be the first sign of the condition. I am glad you didn't fall for this catch in medical work and referred her to doctor.

Answer There are usually two sides to every question; nevertheless I am inclined to agree with your lecturer and personally discard from my lectures all the points you mention. The head should be thrown slightly forwards to prevent swallowing of the blood.

B. S. (Slough) writes:A woman came to our works' surgery complaining that she was feeling giddy, short of breath and of palpitations. She looked pale but there were no other symptoms. In the course of conversation, she mentioned that her bowels were darker than usual. I advised her to see her doctor and she has been away from work now for weeks. I thought she might have a gastric ulcer but cannot under-

Answer (t) In my view there is a small risk of fungoid infection of the feet being passed on in the way in which you describe. This condition is called Athletes' Foot. (2) The wearing of socks which are clean will obviolLsly minimise this risk. (3) The insides of the wellingtons or clogs can be swabbed out with a 1 per cent. solution of Cetavlon.

Answer It prevents inhaling particles of dust, soot, etc., but it has little or no protection against the actual poisonous fumes such as carbon monoxide produced by the fire.

G. C. E. (Oxford) writes:Our lecturer has seriously critizcd the S.J.A.A. treatment for nosebleeding. He does not believe in raising the arms or throwing the head slightly backwards or with the cold application at the back of the neck or putting the feet in hot water. We should be grateful for Dr. Be lilios , views on this argument.

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M. M. C. (Bournemouth) writes:Why is it recommended that in cases of suffocation by smoke the first-aider should protect himself by tying a wet towel or substitute over the mouth or nose.

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FIRST AID & NURSING, JULY/AUGUST 1956

Fractures By. W. James Wright, S.R.N., B.T.A. fracture we mean a broken or ~racked Bybone. A fracture is caused by vlOlence, either direct or indirect, or by muscular action. In a case of fracture by direct violence the fracture occurs at the siteof the: blow, while a fracture caused by indirect vIOlence occurs at a spot away from the site of violence such as falling on the outstretched hand and fracturing the collar bone. With muscular action the sudden pulling of muscles in opposite directions .br~aks a small bone. An example of thIs IS the patella. If the muscles attached to .the top and bottom of the patella beco~e vJOlen~ly contracted the sudden jerk 10 oPPosIte directions pull1l the bone into two pieces. Types of Fracture (a) Simple or closed. There is no wound accompanying this type of fracture, there is simply the broken bone. . (b) Compound or ope.n. There IS a wound leading from the skm surface to the fracture. (c) Complicated. The f~acture is accompanied by injury to some mternal structure such as an organ, bloodvessels or nerves. (d) Comminuted. In. this type of .fracture the bone is broken mto several pIeces. Very careful handling is required in the treatment of this fracture. (e) Impacted. The broken ends of the bone are driven into one another. (f) Greenstick. This type fracture occurs in children. The bone, mstead of breaking completely, bends, like a piece of green stick, hence the name. (g) Depressed. Found in fractures of.the sides or upper part of the skull. A pIece of broken bone is driven inwards causing pressure on the brain. (h) Pathological. This type occurs in certain diseases of the bone, such as tuberculosis and only slight violence may be necessary to cause a fracture.

Signs and Symptoms of a Fracture (1) Pain, swelling and tenderness at, or near the site of fracture. (2) Unnatural mobility (not found in greenstick or impacted fractures) (3) Deformity. Found if the broken ends of the bones overlap. (4) Crepitus or bony grating, due to the broken ends rubbing together. (5) Loss of function. Unnatural mobility and crepitus should never be deliberately sought as further damage may be caused. All these signs and symptoms may not be present in a particular fracture and those which are present may not be very prominent. Further help in the diagnosis of a fracture may be obtained by noting such things as marks on the clothing, or the 'snap' of the bone may be felt or heard. The position of the patient is also a good guide. If in doubt always treat as a fracture. First Aid Treatment of Fractures (1) Do not move the patient until the fracture has been immobilized, unless some other danger threatens his life.

(2) Prevent further damage by immediately supporting the injured part. A simple fracture can easily be made more serious by even slight movement. (3) Treat wounds and haemorrhage first, if serious. Any wounds near the fracture must be treated before completing the treatment of the fracture. (4) Treat for shock by covering y<?Uf patient to keep him warm and by applymg heat if available. Always remember, never tie bandages too tightly, and always fix splints correctly otherwise you may stop the circulation in the affected area an<;i cause gangrene. Surgical Treatment of Fractures If possible a fracture is reduced without an open operation, that is without opening the skin. The patient is given an anaesthetic and the fracture is reduced, the bone being put into as normal a position as possible. In the case of a limb, as soon as the fracture is reduced the limb is encased in plaster of paris, or some special type of splint is applied. In some cases of fracture where there is great muscular contraction, continuous traction is required to prevent the muscles pulling the bone out of place once the fracture has been reduced. One example of this is the femur. Treatment of Fractures by Open Operation This is a means of setting broken bones by mechanical aids and is used when reduction by ordinary means is impossible or unsatisfactory. The operation is performed under an anaesthetic. An incision is made, long enough and deep enough to expose the broken ends of the bone. The bone is freed from the surrounding tissues. An assistant applies traction and the surgeon, with the aid of special forceps, reduces the fracture. Fixation is then achieved by one of the following methods :(a) By wiring, with special wire, the. broken ends of the bone, the wire being passed through holes prevviously drilled through the bone. (b) Special screws or nails. (c) Metal plates secured by screws. (d) Bone grafts, the grafts being taken from the fractured bone or from another of the patient's bones. The graft is secured by screws. Treatment of a Compound Fracture The patient is given an anaesthetic. A large area surrounding the seat of fracture is washed with ether soap and water, the solution being warm. The wound is then covered with a temporary, sterile dressing and the surrounding skin is further cleaned with a good antiseptic such as picric acid or cetavlon. When this is completed the temporary dressing is removed and the wound itself is cleansed. The skin edges are then excised and the full depth of the wound is explored, all foreign bodies being removed. As much damaged tissue as possible is removed. If a compound fracture is treated within a reasonable time and appears satisfactory at the time of

operation, the wound is closed by suturing (stitching) and the fracture is splinted and treated as a simple fracture. It is always advisable to give injections of penicillin. in these cases, and as an extra precaution the wound is usually dusted with some antiseptic powder such as penicillin a~d sulphamezathine. Should the loss of skm be great enough to prevent satisfactory closure of the wound, immediate skin grafting is. perforffil~~ .. If .during the operation, s~gns of septic mfe~tlOn are seen, the wound IS left open and lIghtly packed with sterile gauze impregnated in some antiseptic solution or antiseptic powder. Later, when the wound is clean and satisfactory, it can be sutured under an anaesthetic. How a Fractured Bone Heals Here, briefly, is what takes place in the healing of a fractured bone. When a bone breaks haemorrhage occurs from the broken ends, but after a while blood clot forms around and between the broken fragments. A gradual change then takes place in which the blood clot is transformed into granulation tissue. This is due to an infiltration of white blood cells (leucocytes) and bone repairing cells (osteoblasts) and to ~apillary b~anc~es growing in from adjacent capLilanes. After about 10 days lime salts deposited in the granulation tissue causes a formation of soft vascular bone known as callus. It takes from 6 to 15 weeks, according to the size of the bone fractured, for the callus to become strong enough to bear strain. The change, by condensation, from callus to true bone may take several months to complete.

New Ambulance Station in Wandsworth THE L.C.C.'s new accident ambulance station at 48, West Hill, Wandsworth, was recently brought into service. Simultaneously with the putting into commission of the new station the Battersea Ambulance Station, 119, Battersea Rise, was closed for rebuilding necessitated by war damage and within 6 minutes an ambulance from the new station answered the first emergency call. The station was designed by the Council's Architect and built by H. C. S. Building Contractors, 190, Rye Lane, Peckham, S.E.15, at an estimated cost of £13,560. The new station has two entrances, one in West Hill for staff, and one in Cromford Road for vehicles, and the premises comprise a watch room, appliance room, Station Officer's office, changing room, boiler house, etc., for central heating system and the usual domestic offices. Bulk storage of petrol is provided with electrically operated pump. The establishment of vehicles is the same as was formerly maintained at Battersea Station, namely, one ambulance in continuous commission and two additional ambulances in commission for 16 hours each week-day_ During the first calendar month following its opening, ambulances from the new station responded to 873 calls, 479 of them accident and emergency cases and 394 urgent general removals.

FIRST AID & NURSI G, JULY/AUGUST 1956

FORTHCONITNG EVENTS

Mr. FRED ARGYLE

Friday, Tuesday, Sunday,

28th September, National Fire Brigades Finals, Hastings. 2nd October, Gas Industries Ambulance Finals, Conway Hail. 7th October, Casualties Union, Annual Competitions and Demonstrations , Epsom . Wednesday, 24th October, G.P.O. Ambulance Finals, Porchester Halls. Thursday, 15th ovember, Grand Prior's Trophy, Porchester Halls.

BOOK REVIEWS 'Aids to Medical Nursing '. Published by Bailliere, Tindall and Cox, 7 and 8, Henrietta St., London, \V.C.2. Price 10 6. This is the fifth edition, which follows tne fourth after a comparatively short period of time. The whole of the text has been revised to include new fomls of treatment and recently introduced drugs which have become established in the treatment of disease. At the saine time an addition has been made in the form of a new chapter to cover the new section of the syllabus, which introduces the student nurse to the sphere of mental nursing. On the other hand, the section on Tropical Fevers has been reduced to cover only those diseases which the nUlse is liable to meet in temperate climates and needs to study for examinations.

'They Did Not Pass By', by Denis G. Murphy. Published by Longn,ans, Green & Co., Ltd., 6 and 7, Clifford St., London, "'.1. Price 106. The story of the early pioneers of nursing is told in this book within a smaU compass and in highly readable foml. In each case the author descrices the circumstances of their first efforts, and sketches the subsequent development of the work they cegan. The book stresses the Catholic tradition on which Christian nursing it is claimed is founded. It is true to say that a study of the history of nursing, which is a [Jleasa nt pastime, is part of nursing education.

We have been asked to correCl an error which crept into the caption describing the photC?graph C?f Mr. Fred Argyle' faking' a patient, which appeared in our last issue. Mr. A rgyl~. was referred to as . fonnerly , of L DIViSIon, Metropolitan Police. He is still a valued member of this Di vision an~ captain of their competition ream: whIch wOl;ld be loth to lose his sen ices as an expert first-aider. We would explain that the caption accompanied the photograph, and we deeply regret any inconvenience which the error may have occasioned this well-known officer.

To the Editor Dear Sir, I have in my posses ion a number of old copies of First Aid and Nursing: all 6 copies 1953 and 5 copies 1954, the May June copy excepted. If any of your other readers would care to take these off my hands, I am quite prepared to pass them on. r should like to comment how much my wife and I enjoy reading the articles and comments of your journal. Kind regards to your Staff in their efforts and hoping you can oblige this favour. I am, Yours Sincerely, J. H. ] EFFRlES, 27, hy GROVE, RiPLEY, DERBY.

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bactericidal thus obviating the need, when not convenient, of changing the dressings every day.

the

TREATMENT

PRICE PlVEPENCE 3/6 per Annum Post Paid

for burns and scalds,

FOR CUTS, ABRASIOI"S , BOILS and numerous skin infections, ANTIPEOL is unquestionably the remedy. It is already in widespread use by the medical and nursing professions in many parts of the world.

ANTIPEOL is therefore an essential component of every First Aid and Nursing Kit.

antipeol cutaneous ointment Produced by the makers of: ENTEROFAGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-~NTIPE.OL for .ocular infections; DETENSYL for reducmg arterial. tensIon. MEDICO-BIOLOGICAL LABORATORIES LTD . , CARGREEN RD .• SOUTH NORWOOD,S.E.25

FIRST AID & NURSING, SEPTEMBER,' OCTOBER 1956

BRITISH RED CROSS SOCIETY

UNIFORMS

OFFICERS (MALE) TUNIC & TROUSERS From Government specified materials (Fine Serge-BS 1771) £11. 0.3 (Fine Serge-BS 2551 ) .. . £10.10.5

OFFICERS (MALE) GREATCOAT From Government specified material (Waterproofed melton BS/ I77I) .. . £7. 4.1

BARNETT MITCHELL LTD. MITCHELL HOUSE, 228,

OLD

STREET,

LONDON,

E.C.I

CLErkenwell 9274/5

GREATCOAT (Heavy melton cloth)

September jOctober 1956

£1.17.4 £2. 9.1

PATTERNS ... £6. 6.10

AND

PRICE

LIST

CAN BE. SUPPLIED ON APPLICATION

PURCHASE TAX TO BE ADDED TO ABOVE PRICES

Nursing Editor: Peter I. Craddock

MEMBER (MALE) TUNIC From Government specified materials (Rough serge) £4. 0.7 (Fine serge) .. . £4.16.2 TROUSERS (Rough serge) (Fine serge)

First Aid

In this Issue Eq uipping a First Ai d R oom

.·c~ . PATENT

AMBULANCE GEAR

no you know that •• •

The UP AND DOWN action is qUick and easy for loading or unloa<ling: A . Shows the two stretchoers in position. B. S hows the top stretcher lowered ready

for load in g. C. Illustra tes the same Gear with the top stretcher frame hinged down for use when only one stretcher case j& carried.

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

65, WIGMORE STREET, LONDON, W.I 'Phone I WELbeck 0071 (Lat. GREAT PORTLAND STREET)

5 From a Seat in the Audience 9 10 Rea ders' Queries Head Fi rst 12 Fi rst-aider's Crosswo rd 12 A Revised B. R.C.S. Tex t book J 4

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

Full cattl/olue of Ambulance Equ ipment No.7A will be .sent on request.

Casualties Union Notes Competitions ...

"PORTLAND"

Where Ambulances are required to carry four beds two Gears are fitted. one on EITHER SIDE, and t"'e same advantages apply as described above.

D iseases of the R espiratory System...

Chilblains are nne in the United S ta tes and Canada, where central heating is a lmost universal ? Vitamin B I is formed in the lea ves of plants and passes to the roots, the growth of which it stimula tes? The virus of human influenza was no t isola ted until 1932 ? The S outh A merican Indians use tubocuraine, an arrow poison, which paralyses the muscles, instead of an anaesthetic ? The skin of the arm-pits and groins is more absorbent than that of the palms of the hands? One out of every two women in Great Britain ha ve chilblains before the age of 40 ?

Equi]Jpillg a Ilirst Aid Boom First Aid in Industry ]\'ot very ma ny years ago it was exceptional to find a first-aid room wlless 500 or more were employed. T oday, however, first-aid rooms are found in units sometimes with less tha n 200 employees a nd in the bigger works there is a significant cha nge in the designation-the fi rst-aid room no w beco ming known as a health centre. Even the smaller industrial units are find ing that part-time attendance of a factory medical officer is desirable, and, of course, he has to be suitably housed. The fo llowing is written as a help in equippi ng a first-aid room where profess io nal guidance is not available. As far as possible a first-aid room should be central, reasonably quiet, warm and with easy entry for a stretcher and accessible to transport. Where space permits a small waiting room should be arranged. Toilet facilities, if not provided, should be nearby. H ot water should be available with the sinks, preferably fitted with aseptic taps, a nd where foot injunes are common, a sink at floor level is most Llseful. Some of the basic necessities of a small ambulance room are:An examination couch, surgery chairs, chair with arm and head rest, drug and dressing cabinet, dressing trolley and in strument trolley, hospital-type screen, adjustable lamp ff)r eye work, soiled d ressi ng bin, desk OJ table. Where juvenile Jabour is employed and examined periodically by the doctor, a

weighing machine, sight testing chart and height measuring standard should be provided. Other items of equipment to be considered are as follows:Hot water bottles, blankets, stretcher or carrying sheet, sterilizers-instrument or dressing, dressing bowls, 4 in., 6 in., and 8 in., small gallipots, clinical and wall thermometers, kidney-type dressing trays, 4 in., 6 in. and 8 in., boxes for instruments, with Fitzwell lids, dressing jars with lids, small instruments such as scissors, dressing forceps , artery forceps, instrument wall cabinet. Chemical and similar works and cyanide hardening plants with their special hazards need specialized equipment to deal with major mishaps. Eye irrigators should be provided, always bearing in mind the recommendation that for acid or alkali burns of the eyes, the eyes should be irrigated for up to an hour to prevent permanent damage. In works where accidents are liable to occur above ground level, i.e. in cranes and on gantries, a eil R obertson type of stretcher jacket makes the difficult task of lowering badly injured or unconscious workmen much easier.

Reprint of an article published ill the 1956 edition of' Safety and Health in Industry,' published by Sky Press Ltd., PorteollS HOllse, Porteous Road, London, W.2.

Special Cabinet Many works ambulance rooms and surgeries are very cramped for space and where this exists such readers will be very interested in a llew cabinet, o . S.699, Cuxson, Gerrard & Co. Ltd., Fountain Lane, Oldbury, Birmingham, have recently introduced. This cabinet has been specially designed to combine a storage cupboard and di spensing table thus saving considerable floor space and, in addition, all dispensing requirements are immediately to hand. The fall front of the cabinet size, 3 ft. x I ft. 6 in., has a formica top forming an ideal dispensing table, and a lock-up D .D .A. cupboard is built in behind the fall front. The' top p ortion has sliding glass doors and the lower half, fitted with one shelf is for the larger items. O verall the ca b i~et measures 6 ft. x 3 ft. x 1 ft. 6 in" includi ng a 5 in. ipset black plinth. This latter does not show shoe marks and dust does not collect underneath, in fact dust collecting ledges .h ave been eliminated throughout. The construction is of the Company's usual high standard of :t in. solid timber finished white enamel.

Forthcoming Events Wednesday, 24th October: General Post O ffice (me n an d women), Porchester Halls, London, W.2, 9.15 a,m. T hursday, 8th November: D ock and Harbour Authority, Porchester Halls, London , W.2, 9.30 a.m. T h ursdaY, 15th ovember: Grand Prior's Trophy, Porchester Halls, London, W.2, 9.30 a.m.

The Cuxson, Gerrard new cabinet.

Brigadier T. D. DaIy Following the death of Sir Otto Lund, Brigadier T. D. Daly, CB.E., M.C, K.St.J., has been appointed Acting Commissioner-in-Chief of the St. John Ambulance Brigade. He was educated at Rossall, Munich and Oxford, and has held a number of important appointments both military and civil in many parts of the world. He joined the St. John Ambulance Brigade as D eputy Commissioner-in-Chief in 1951. Much has been written in the national press on Sir Otto Lund's untimely death and at this time we feel that we cannot add anything further, except to mention th~t the 'Save-a.-Life Week' organized by hml las.t year will. be continued annually. A fittmg memonal, of a kind we know he would have wanted.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

A Course in Elementary Medicine

Diseases of the Respiratory System

time past, we have F ORbeensome running in these columns a Course in Elementary First Aid and in the last article we dealt particularly with certain illnesses with which a first-aider was likely to come into contact. It is now proposed to give pure first aid a rest and to consider some of the more common ailments to which the human body is liable; in this way the first-aider will increase his general knowledge of medical work. This study of elementary medicine, as the series will be called, is also of value ill many other walks of life. Diseases which affect the respiratory system have been chosen for this article for they will certainly become prevalent during the winter months that lie ahead. The description of each ailment will include a brief account of the essential structure of the organ which is affected. Colds These, of course, affect the nose which consists of two triangular passages leading from the nostrils to the throat. Each cavity is covered with a red lining called the mucous membrane because it secretes mucus or slime. The common cold, or acute coryza as it is called technically, is caused by infection with a virus which is an organizm too small to be seen by an ordinary microscope. The ailment is spread from one person to another by the breath and by 'droplet infection.' The latter occurs when a sufferer from a cold, usually in its early stages, coughs or sneezes. In this event showers of invisible little droplets of mucus from the nose and mouth are scattered and may be inhaled by others who are near by. These droplets contain the virus and thus the ailment which is highly infectious is spread from one victim to another. The symptoms of a cold are caused by inflammation of the mucous membrane. The first sign is usually that the patient notices discomfort in his nose often amounting to a dry raw feeling; it is at this stage that

By A. David Belilios M.B., B.S. (Lond.), D.P.R. (Eng.) the ailment is probably most infectious and may cause loss of appetite, a slight temperature and a general feeling of ill health. This is soon followed by stuffiness, the cavities of the organ being partially obstructed by a thick slimy secretion which can only be removed by the repeated use of a pocket handkerchief. Within a few days, however, the discharge becomes thinner and more readily removed by blowing the nose; the patient becomes more comfortable as the effects of the inflammation gradually subsides. Complications of a cold are not uncommon and may include spread of infection to other organs of the respiratory system. Thus, if the process spreads downwards, inflammation of the voice box (larynx), wind-pipe (trachea) or bronchi may occur. These conditions will be considered later. Sometimes the infection spreads to the sinuses. The frontal bone, e.g. which forms the forehead contains two cavities called the frontal sinuses which lie one over each eye towards the mid-line where prominences can be felt just above the eyebrows. These cavities, which contain air, communicate with the nose. Similarly larger cavities called the antra are found in the two larger bones which form the cheeks. If the inflammation of a cold spreads to one or more of the sinuses or antra, pain, sometilles accompanied by a raised temperature, may result caused by the cavities being filled with thick mucus or even pus. Adenoids At the back of the nose in that part of the throat which is above the level of the soft palate, there is some lymphoid tissue very similar in appearance and structure to the tonsils . Often, particularly in children, as a result of chronic infection, this lymphoid tissue becomes enlarged forming adenoids which partially obstruct the nasal cavities. Frequent colds, snoring and mouth breathing are the usual symptoms of this complaint but

often the adenoids become small and cease to cause trouble as the child grows older. Complications, however, are not unusual and are due to the fact that there are two little tubes leading from the back of the nose to the middle ear. If the adenoids encroach on the openings of these eustachian tubes as they are called, the free passage of air from the back of the nose to the middle ear is prevented and the patient may suffer from impaired hearing. Should infection from the adenoids spread up the tubes, an abscess in the middle ear may result-a complaint called otitis media which is associated with severe pain, a raised temperature and probably a discharge containing pus from the ear. When adenoids cause complications as above described, they have to be removed by operation. Pharyngitis The pharynx is the space situated at the back of the mouth and nose, it belongs to both the respiratory and digestive systems since air and food pass through it. Its walls are made of muscle and it is lined by mucous membrane similar to the covering of the nose and mouth. Pharyngitis may be acute or chronic; these terms may call for some explanation. An acute ailment is one which begins suddenly and runs a rapid course and ends comparatively quickly. A chronic illness, ·however, develops gradually and continues for a long time, often being difficult to cure. Acute pharyngitis is generally the result of the downward spread of a cold. It may also be caused by injury to the mucous membrane or by drinking fluids which are too hot, by corrosives and by inhaling chemical vapours. Symptoms and signs vary with the severity of the case. The voice is usually thick and husky while there is also a feeling of discomfort in the throat which may amount to actual pain. In severe cases, such as occur from poisons the mucous

FIRST AlD & NURSING, SEPTEMBER/OCTOBER 1956

membrane may be so swollen that there is difficulty in swallowing. Chronic pharyngitis may be due to many causes such as unhealthy tonsils, teeth and ailments of the nose which cause mouth breathing in which event air inbaled is insufficiently warmed moistened and filtered as is the case when the patient breathes normally through his nose. Over-smoking, too much alcohol and the repeated inhalation of irritating dust and vapo urs in various occupations are also important causes. Symptoms include discomfort in the throat which has frequently to be cleared, a husky voice and a , smoker's cough '. It must be emphasized, however, that no cough must be assumed to be due to smoking or other cause of chronic pharyngitis. Any cough which continues for three weeks or more must be investigated by a doctor. Laryngitis This is inflammation of the larynx or organ of voice which in many people fonus a slight prominence in the upper part of the neck known popularly as the 'Adam's apple.' Air which is breathed in passes through the nose and pharynx and then enters the larynx through an opening called the glottis. The organ is made up of ring-like cartilages-the thyroid and cricoid which are supported by fibrous and muscular tissue; it is lined by a mucous membrane. Stretching across the organ from front to back are the vocal cords which produce the sound of the voice. Laryngitis may be acute or chronic. The acute variety may result from the downward spread of infection in a cold, the inhalation of irritant vapours or may occur as a complication in other illnesses such as influenza and measles. It may also result from excessive use of the voice e.g., shouting at a football match. The most important characteristic is alteration in the voice which becomes husky, hoarse or even completely lost. There is usually an irritating cough often accompanied by the production of a small amount of phlegm. Irritation of the throat and occasionally pain in the region of the larynx may occur. These local symptoms are frequently associated with a general feeling of ill health such as fatigue, loss of

appetite and perhaps a mild temperature. An attack may last anything from a few days up to weeks. Chronic laryngitis may result from repeated acute attacks, faulty voice production, over smoking, etc. Its characteristic is a permanently husky voice and generally a chronic cough. Tracheitis The trachea, sometimes in popular language called the wind-pipe, is a tube about 4~ in. long and I in. in width which carries air down the neck into the chest. It is made of muscle and fibrous tissue and is strengthened by C-shaped rings of cartilage which prevent it from kinking when the neck is bent. It is lined by a mucous membrane continuous with that of the larynx. Tracheitis is ;n fact a common ailment although its name is not well known outside medical circles. The illness consists essentially of inflammation of the mucous membrane lining the trachea and often results from the downward spread of a cold. The mucous membrane passes through similar stages as occur in the nose. The patient suffers from a cough which is at first dry but within a few days is accompanied by the production of white, frothy and slimy phlegm later becoming yellowish in colour. Other symptoms which may occur, particularly in the early stages include a raw feeling in the lower part of the neck, loss of appetite and a feeling of being generally run down. Tracheitis is one of the commonest causes of severe coughs from which so may suffer during the winter months. It is often confused by the public with bronchitis which, however, is a more serious ailment. Bronchitis Soon after entering the chest, the trachea divide~' into two tubes, similar in structure to itself. These are called the bronchi and lead one to each lung which they enter at its root. Each bronchi then divides and sub-divides into an enormous number of branches which become smaller and smaller as they distribute themselves to all parts of the lung. This branching of the bronchi is similar to the branching of a tree and for this reason is often called the bronchial tree; the smallest branches are known as bronchioles

and eventually open into tiny pockets of the lung tissue which are called the air sacs. Bronchitis is inflammation of the bronchi and its branches and may be acute or chronic. The acute variety is caused by germ infection although sometimes it results from the inhalation of irritating vapours. The germ infection may be the result of the downward spread of coryza, pharyngitis, laryngitis or tracheitis and the complaint is a common complication of 'flu, measles and Whooping cough. It is thus aggravated by exposure to wet or cold and hence is most frequent in winter and foggy weather. Children and old people are particularly liable to the ailment. The mucous membrane of the bronchi pass through the same stages as have already been described in a cold hence the symptoms can readily be worked out. The disease begins rapidly with a raised temperature and all the general disturbances that go with it. There is soreness of the chest and a dry cough. At first only a small quantity of frothy mucus is produced with difficulty as phelgm. Later the cough becomes loose and a yellowish slimy sputum is produced usually with and in larger quantities. Shortness of breath is a common symptom and in bad cases there may be cyanosis. Wheezing in the chest can also be heard. The ailment lasts from one to two weeks-sometimes longer; a cough may persist for some time. Complications include bronchopneumonia, and, particularly in elderly people, weakness of the heart. Chronic bronchitis is not uncommon in elderly people and results from repeated acute attacks. Ultimately the patient develops a 'winter cough' which as its name implies, persists throughout the winter months, frequently beginning from the first cold that the patient contracts in the autumn. The main characteristics are a persistent cough which produces a variable amount of sputum, shortness of breath particularly on hurryina or with exertion and wheeziness breathing. There is not usually a temperature and the patient, although in a lowered state of health, manages to live a reasonab~y comfortable life although he IS naturally limited in his activities.

FIRST AID & NURSI G, SEPTEMBER/OCTOBER 1956

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

Casualties Union Notes NEWS FROM THE BRANCHES Members of Casualties Union throughout the country have these pas~ months, been very busy providing casual.tles for a.1l the major first aid groups. Praise of the!r work has come from all quarters, and t~IS year records will be even larger than III the past. All members have been busy concentrating on the Casualties Union's. <?wn trophy, the Buxton. Trophy CompetItlO.n, which was held thIS year at the Mobile Defence Corps Depot (by kind permission of the Commanding Officer) East Street, Epsom, Surrey, on Octob.er 7th .. One side of Casualtles UUlon work which is increasing steadily, is the provision of casualties for home nursing courses. This is developing into quite a feature, especially as the women members of the large first aid groups, have III addition to their first aid examination, to take one in home nursing. Two very interesting displays of these casualties were given recently by branches of Casualties Union, which included the following ; AHrincham Branch A staged display of bed treatments, which alternated with a floor display of minor treatments, viz.;The treatment of post operative patient, on return from the theatre; removal of sutures and clips from two faked wounds; gastrostomy feed; the removal of F.B. from the eye, and the treatment for a discharging ear; an accident case being admitted to hospital; demonstrations of various types of respiration, air hunger, dyspnoea, cheyne stokes, stertorous, etc.

This display was staged with full hosp,ital equipment, and furniture, etc., the Medical Advisor of the branch acted as the ward doctor, a trained nurse as the ward sister, and branch members as nurses and casualties. Norton Branch A second display given by the above branch on three different occasions, included;Preparation and administration or. a (mOCk) blood transfusion; demonstratlOn of the nursing of severe burns of the back, showing the nursing of a patient. in the prone position; treatment of septl~ conditions, e.g. boils, carbuncles, whitlows, etc.; specific fevers, which included, measles, scarlet fever, mumps, and erysipelas. . . From the casualties point of View, thiS work is a change from the usual routine of street or home accident, also as a number of women members of Casualties Union, also belong to the large first. aid groups, it can incorporate tw<? meetl~gs into one night, the Casualtles UUlon members, acting as casualties, and also being present for the lectures. It may not have occurred to aU first aid groups that Casualties Union will provide casualties for this nursing course, but if they will contact their nearest branch or Study Circle of Casualties Union, they will find that mutual benefits to both organizations, can be arranged. Many More Records Civil Defence and N.H.S.R. requirements have increased enormously, all over

the country, and it looks as though the number of records will be even greater. CU. members were given a grand reception when they v~sited Gilwell P ark to give a demonstration to a rally of Queen 's Scouts .. It is hoped t~ be repeated at an internatlOnal gathenng of Boy Scouts at Sandringham in the near future. Casualties Union believe in catching their first aiders young. . Yet another course of CU. technique was arranged on behalf of the B.R.CS. at their National Training Centre at Barnett Hill, and this has encouraged the forn:at,ion of more Study Circles for the CU. tramIng. Some of the students were attending for the second time because they said they found the training'so valuable for various aspects of Red Cross work. A Training Day at Halifax was held in September, and was enjoyed by other branches and an audience of first-alders, from all groups. These training days are very instructive, and all branches and Study Circles within travelling distance take part. A conference of all branches and Study Circles has been held in Scotland, with a view to forming a Scottish Region of Casualties Union, we wish them all success, now then Wales and Ireland-what abouL it! Overseas News Three new Study Circles have been formed in South Africa, one in Norway, and a new one in Canada, this brings the Canadian total up to five. We are very proud of these overseas ch!ldren of ~urs, and wish them success, III what 1S to some of them an entirely new venture in the realms of first aid.

Confessions of a Competition Casualty Having been a first-aider for years, and now a member of Casualties Union, I have discovered that;1 do not like being told 1 am milch befter, when 1 am not. A proper drink of water or tea is better than pretence with an empty Clip. It is ~'ery exasperating when great trouble

has been taken with make-up and acting, to hear the /irst-aider ask, ' Is the patient pale, doctor, do 1 see blood?' That some first-aiders are so modest, fhey would let me bleed fa deafh because 1 had a severe haemorrhage above the knee. 1 can expect more gentle and considerate handling /rom Boy Scouts, than 1 can /rom

Portable atomic device takes' on the spot' X-ray pictures

A portable atomic X~ray.unit,. designed for

use in emergencIes, IS belDg tested by the United States Army, and may be available for civilian use at a later date. It weighs only 48Ib., can be carried and operated by one man, an~ produ~es a finished picture within 10 mllutes WIthout electricity, water, or a dark room. , On-the-spot ' X-ray pictures which this device takes, can be useful in several ways. They determine the exact nature of a wound or injury without moving the victim. They can be sent to hospital with or ahead of the patient, enabling the doctor there to decide on the best course of action without delay. And in cases of critical injuries, quick X-ray pictures can be the means of saving lives. The atomic substance that powers this portable X-ray is a capsule of radioactive

thulium about the size of a pea, surrounded by lead plate to protect the user from exposure to radiation. Under normal use, this capsule remains potnnt for a year, after which it can be rejuvenated in a nuclear reactor. The capsule and its lead shield are packed ready to carryon a man's back. Included with the unit is a ' self-contained' cassette or holder in which the pictures are made with radiosensitive paper and pads instead of film. The paper and pads are saturated with developer and stabilizer, separated by leak-proof dividers. The cassette is wrapped in a light- and water-proof covering. When it is exposed, the dividers are removed and the radiationsensitive paper makes the X-ray picture, called a radiograph. The exposure is timed with a wrist watch.

grown men who' knew the book' a/ld then forgot 1 was a human being in pain. What a charming approach children have fo the ill and injured. How nerpe shattering it call be to hal'e your dentures remol'ed and find oneself hustled into an ambulance, and no one hailing a clue as to their whereabolIIs.

An Unsolicited Testimonial The following story was related Lo us recently by Divisional Surgeon T. ScottReid, M.B.E., M.B ., Ch.B., of Somerset, a well-known competition judge.

Competitions National Hospital Service Reserve (Mobile Units) Finals

THE Ministry of Health must be either

psychic or in league with the Meteorological Office. For the past three years this spectacular event has been held on Horse Guards Parade, and has been blessed with fine weather. Perhaps it was felt that to attempt this a fourth year would be tempting Providence, so it was decided this year to hold it under cover, and it was staged in the Friends' Meeting House, Euston Road. The weather ultimately proved the wisdom of this decision. However, despite the difficulties presented by the limitations imposed by the reduced exhibition area, they detracted little from the settings, and certainly nothing from the enthusiasm of both competitors and spectators. . The competitions were open to all Mobile First Aid Units (N.H.S.R.) in England and Wales, and 232 units had taken part in eliminating contests in the 14 hospital regions into which the countries had been divided. Regional finalists competed in four area semi-finals, and the four winners from these semi-finals were now competing in the finals for the Minister of Health's Challenge Cup, which had been held for the past year by Chase Farm Hospital, representing Enfield Hospital Management Committee. For the benefit of those who may be expecting a report of a first aid competition similar to those staged by the great teaching organizations, it must be explained that the Mobile Unit attached to a hospital performs a special function, for which it receives a specific training. Each team consists of a medical officer, a trained nurse and eight (usually nine) auxiliaries who are members of the N.H.S.R., and carries in a 30 cwt. van all equipment for establishing a temporary casualty department. The members of the team follow in cars. The medical officer of the team diagnoses and prescribes and the trained nurse directs the nursing operations which are carried out by the auxiliaries, one of which is a motor cyclist who, besides taking part in the first aid work, is available for communj~ation duties. Marks are awarded by the Judges [or: (1) Turnout of personnel, discipline upon arrival, evidence of clear apportionment of duties,

(2) Method of unloading, unpacking and laying-out of equipment, (3) General organization of unit with regard to facilities for treatment, etc., (4) Reception , documentation, treatment and disposal of casualties. PREPARATION OF CASUALTTES In a large room behind the stage marked 'PRIVATE-CASUALTIES UN10N,' we discovered an army of members of the Casualties Union preparing and impersonating the casualties which were to be treated by the competitors. This army, in charge of the secretary, Mr. P. Sargent and his assistant, Miss Elston, were under the direction of Dr. Lancelot K. Wills, who has specialized in casualty make-up, and acts as technical adviser to the Union. ot only are the members trained in make-up, or 'faking' casualties, but also in acting the parts, and it i this technique which has contributed the realism to modern competitions that proves so valuable to our students today. Of the many injuries we saw' faked' there \vere simple fracture of forearm, abrasion of face, fractured jaw with haemorrhage (arterial haemorrhage was represented in a most natural manner by means of a rubber ball and tube, pumping red fluid rhythmically), laceration of hand with foreign body embedded, flash burn (the patient was also simulating shock), fractured fibula with bleedir:tg varicose vein, paraplegia and wound In back, punctured wound in thigh with haemorrhage and shock, multiple internal injuries with bleeding from all points, etc. Truly a diabolical scene. We then returned to the competition hall. THE TEST The competition this year had been arranged primarily as a test of initiative andftexibility of organization in the competing teams. Action started with a group of casualties (four walking and one stretcher case) waiting in a cleared space on the edge of a devastated ap~a for the arrival of a M.F.A.V. They had been sent there by a rescue squad for medical treatment. It was assumed to be at Woolwich, ten miles from the unit's base hospital. The unit arrived, and the medical officer reported to the Post Controller, who gave

him a brief account of the situation and showed him the building (the arena) which had been allotted to the unit. The medical officer then made a quick survey and instructed the team how the unit was to be deployed , bearing in mind that they might have to deal with a large number of casualties. The doctor and trained nurse aided by the .H.S.R. auxiliaries, examined and treated the casualties, the doctor deciding which should be sent to hospital by ambulance, making sure in each case that the casualty was in a fit state to stand what may be a rough journey over damaged and debris-littered roads. Particulars of all casualties were recorded by a member of the unit. The Post Controller detailed stretcher-bearers to remain with the unit to assist in moving the stretcher cases inside the building. Whilst thus engaged an intruder, who had obviously gone berserk, created some confusion by rushing in and demanding help to dig out people trapped in a cellar close by. Whilst causing considerable amusement to the spectators. the incident proved an excellent test of the tact and ingenuity of the competitors in quietening him and getting him out of the way. This' nuisance' took his part well. Two more injured casualties were brought in followed by two severely injured persons on stretchers. The procession finally ended with two stretcher cases. The Post Controller then told the medical officer that, owing to a change of wind, there was a serious threat of fire in the area in which the unit was working. and they had five minutes in which to g~t the casualties away and pack up their equipment. Units were expected to evacuate by ambulance or sitting-case car only those casualties deemed to be in need of further immediate treatment in hospital. Ambulance cases were removed by stretcherbearers to the ambulance loading-point (off stage). Walking cases deemed to be fit to return to their home or to a rest centre after treatment were despatched on foot in the care of an escort provided, on request, by the Post Controller. After an interval for refreshments, during which the judges were engaged in assessir:tg the marks, the teams were draw,n. up III formation and inspected by the Mmlster of

Dr. Scott-Reid told us that it has been his practice for a long time past to place First Aid and Nursing in his waiting room after he has read it, hoping that it might prove of interest to some of his prj~ate patients. One evening a lady patIent entered his consulting room holding a copy of First Aid and Nursing in her hand , and upon being asked what could be done for her replied 'Really, doctor, I don't know. I've been so interested in this journal which I found on your table that I have forgotten what 1 came for'.

(Extreme Ie/f) The winners of the Minister of Health's Challenge Cup were the team from St. Tydfil's Hospital representing the Merthyr Aberdare Hospital ~anage ment Committee, shown here With the Minister Mr. Robin Turton, and Miss Hornsby:Smith, Parliamentary Se~retary to the Ministry of Health. Holdmg the cup is Dr. lain Roy Stewart Robertson, Chairman of the We] h Board of Health, and others.

The story was related to us in all seriousness !

(Left) The Faversham Hospital team, representing the Canterburr Group H.M.C., in ~ctjOI1,

Competitions . Health, Mr. Robin H. Turton, M.P. He was accompanied by Miss Pat HornsbySmith, Deputy Secretary to the Ministry of Health· Dame Elizabeth Cockayne, D.B.E., Chief Nursing Officer to the Ministry of Health, and others. Returning to the rostrum, Mr. Turton was supported by Miss Pat Hornsby-Smith, Dame Elizabeth Cockayne, the Mayor of st. Pancras, Councillor A. C Hurst and Mr. H. H. Davies, M.C., Chairman of the Welsh Board of Health. The announcement of the results followed: RESULTS 1. Merthyr and Aberdare H.M.C, represented by st. Tydfil's Hospital, MerthyrTydfil ... 421 (winning the Minister of Health's Trophy) 2. East Cwnberland H.M.C, represented by Cumberland Infirmary, Carlisle 378 3. Canterbury Group H.M.C, represented by Faversham Hospital ... 350 4. Sheffield Operational Group, represented by Sheffield 'A' team ... 343 The total number of marks obtainable: 500. In presenting the trophy Mr. Turton referred to the fact that it was the first time that the Competitions had been held indoors, but, he said, this had proved lucky·. He had just heard the results, and was delighted to learn that the Trophy this year had gone to Wales. 'What struck me most,' he said, 'was the tremendous enthusiasm of those taking part in the contest. It is most gratifying to note the skill which has been exhibited here by these members of the National Hospital Service Reserve. It is most necessary, however, that all should possess a knowledge of first aid and nursing. Unfortunately, peace has its emergencies and accidents no less than war, and for our peace of mind we should equip ourselves to deal with both. I beEeve that everyone should face the possibility and prepare, and one way of doing this was by joining the National Hospital Service Reserve, for which initial training is provided by the St. John Ambulance Brigade and the British Red Cross Society. The IIi- million attendances at hospital casualty departments each year shows that the chances of everyone needing to make practical use of a knowledge of first aid were obviously many. It is, moreover, most important that we should have trained skill in the Reserve. That is why I am so grateful to the S1. John Ambulance Brigade and the British Red Cross Society for training, not only their own members, but any who apply to them to become students. If thermonuclear war were to come we would have to face far more than we had ever faced before. I feel that it is very important that we should get more recruits. The more we know of first aid the better we shall be prepared for any emergencies which may arise.' He went on to emphasize the value of first aid in civilian life, reminding his hearers that of the 1t million casualties which take piace annually in the home a very large proportion involved children. Mothers should realize the importance of acquiring a

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956 7

knowledge of this valuable subject, and by .joining the N.H.S. R . they are, at the saI?e time, preparing themselves for emergencles which may arise in the home. 'No one,' he concluded, ' is wasting his or her time by learning first aid and home nursing.' After having presented the Minister's Trophy to the winning team Mr. Turton said that he wished, on behalf of his Ministry as well as of himself, to thank aU those who had helped to make the event a success. He mentioned in particular the judges, R. H . Barnett, Esq., M.R.C.S., L.R.CP., D.P.H., Senior Medical Officer to the Ministry of Health; Major-General J. C A. Dowse, CB., CB.E., M.C, M.R.C.O.G., Medical Officer to the Ministry of Health and Miss J. Addison, D.N., Matron of Guy's Hospital. They had had a very difficult task, and he and the Ministry were most grateful to them for having given of their time and skill to judge the competitions that day. He thanked the County of London and St. Pancras Division of the Civil Defence Corps, the St. John Ambulance Brigade, the British Red Cross Society and the Casualties Union for the parts they had played. He regretted that it was impossible to mention by name all those who had helped. Of the many well-known personages present we noticed Mr. Mackenzie (Department of Health for Scotland), Mr. and Mrs.

Hewison (Home Office), Miss Craven (Matron-in-Chief, B.R.CS.), Major WhiteKnox (Surgeon-in-Chief, S.J.A.B.), Mrs. Grosvenor (Deputy Superintendent-inChief, S.J.A.B.), Air-Commodore Hewat (Medical Adviser, B.R.CS.), Miss Robinson (Department of Health for Scotland), Lady Hillingdon (W.V.S.), Miss N. Hamilton-Wedderburn (Chief Nursing Officer, S.J.A.B.), Mr. R. C E. Austin (Town Clerk, St. Pancras), Mr. and Mrs. Paterson (Home Office), Mr. H. H. Davies (Welsh Board of Health) and Miss M. Young-Jamieson (Director, Wpmen, Home Department, B.R.CS.). This annual event again afforded an excellent opportunity for the meeting of the uniforms, but there is still too much segregation. We would like to see, not merely the meeting, but the mingling of the uniforms. True, we did see more than once one very popular 'black-and-whlte' lady right in the midst of a bunch of' redand-whites.' That is as it should be, for we should try to get to know each other better. What does it matter which flag floats over us? We are all working in the same cause, viz., the saving of life and the alleviation of human suffering. If this is to prove a step towards the attainment of that ideal state to which we all look forward, the universal brotherhood of man, then our work will not have been in vain.

National Road Passenger Transport Finals The gigantic garage at London Transport Aldenham Works, Elstree, Hertfordshire, which usually houses scores of London 'buses, was recently transformed into an ideal arena where a dozen teams of both men and women from all parts of England and Wales competed in the annual competitions of the National Road Passenger Transport Ambulance Association. The competitions were held under the auspices of the St. John Ambulance Association in conjunction with the London Transport Ambulance Centre. Despite the distance from London a very large audience had gathered to witness the tests, certain evidence of the popularity of this annual event. Once again the latest method of staging had been adopted, the whole of the competitions taking place in the centre of the arena, thus saving spectators the fatigue of walking from room to room to witness the various tests. These were, as usual, of a most interesting character. Men's Team Test, set and judged by Dr. J. C. Graham: The team is waiting for a train at a small country station when they are asked to attend a man who has fallen from a truck. Injuries: Wound on left temple with concussion, simple fracture right clavicle, wound in palm of right hand, simple fracture left patella. Women's Team Test, set and judged by Dr. Olive May: Calling upon a friend they receive no reply to their ring, and upon entering the house find their friend lying on the floor by an overturned pair of steps. Injuries: Contusion on rigbt side of forehead with concussion, simple fracture of left forearm, simple fracture of right fibula.

Dual Practical Tests, set and judged by Drs. R. Renwick and Lancelot K. Wills: Nos. 1 and 3 are asked to attend to a man who, whilst carrying an open knife fell over a chair. J njuries: Compound fracture of right forearm, sprained ankle, shock. Nos. 2 and 4 see a man stumble over the kerb and fall to the ground. rnj uries: Fractures of 7th and 8th left ribs, strained left calf muscle, shock. Each member of the team had to answer two oral questions which were set and judged by Drs. Sheila M. Niall and F. H. Taylor, O.B.E. The competitors and guests were entertained to a sumptuous meal, after which the trophies were presented by Horace F. Parshall, Esq., T.D., M.A. (Oxon.), Director-General of the St. John Ambulance Association. Presiding over the ceremony was J. B. Burnell, Esq., CB.E., J.P. , M.Ins1.T., President of the National Road Passenger Transport Ambulance Association and Operating Manager (Central Road Services), London Transport Executive, and he was supported by Horace Parshall , Esq ., a nd Mrs . Parshall, Alex. J. Webb, Esq., M.Tnst.T., (Chairman of London Transport Ambulance Centre and General Superintendent (Staff and Training) Railways), London Transport Executive; Dr. L. G. Norman, YicePresident of London Transport Ambulance Centre and Chief Medical Officer, London Transport Executive; H. D. Lewis, Esq., Hon. Secretary, N.R.P.T. Association; George Craft, Esq., Competition Secretary, S.J.A.A. and the judges. The chairman opened the proceedings by welcoming Mr. Parshall and his charming wife, paying high tribute to his work as

Director-General of the St. John Ambulance Association. However, he would not keep his audience in suspense, and he asked Mr. Craft to announce the results: MEN'S COMPETITION 1. London (Chiswick) ... ... 497 (winn!ng the ~tirk Trophy for the thIrd year m succession) 2. Liverpool ... ... 48n 3. Birmingham 46U 4. Cardiff ... 398 5. Plymouth 395 6. Nottingham 381~ 7. Huddersfield 366 WOMEN'S COMPETITION 1. London (Rei gate) ... (winning the Lewis Cup) 2. Liverpool 3. Midland Red 4. Coventry 5. Cardiff

382t 377 ~ 297l 261 .l. 250-

The Chiswick Women's Team, which forn:erly represented London, received a speCIal and unexpected award, for each member was presented with a small silver cup, the gift.of H. D. Lewis, Esq., the donor of the. LeWIS Cup for women, for having W0n hIS own Cup four times. Comments on the work of the teams were then given by the two team judges and Dr. Graham opened the ball. He said that it was difficult to make any adverse comments, for he had never seen such a higb standard before. It had been outstan~ing. It was only by picking out detall tbat he had been able to differentiate. The first two teams had been almost perfect. He would, tberefore, mention one or two of those details. Some had lost a few marks on examination of the patient. Diagnosi~ was not quite thorough enough. He admitted that with an unconscious patient little can be done, but they must prepare for the moment of recovery. Documentation can always wait

until the more urgent needs of the patient hav~ b~~n attended to. He thanked them for Il1vltmg him. He was followed by Dr. May, who said ~ba~ she felt honoured by having been mVlted to judge the women's team test. It h~d also been a great pleasure to meet old fnends. The teams were to be congratulated. Most of them knew their first aid tboroughly, and also how to apply it. Then: were. others, however, who should exercise a little more care in examination of the patient. She thanked all who had helped her, and especially her patient, WhICh had made her task so much easier Mr. Webb said that he wished to th~nk al I for coming there that day to support the teams, b.ut he had a special ' Thank you' for the Judges, for no competitions could be held witbout their help. There were so many that he would like to thank individually, but he must be content to mention but a few names. First of ali, Mr. Craft, whose valuable work as competition secretary to the St. John Ambulance Association was so well known to them all. Mr. Har~en, the Centre secretary, was the man behind the scenes, and upon whom so much depe1!ded, together with his army of stewards, tlIDekeepers, etc., which he had collected together had proved invaluable. The 'patients' and 'fakers' whose work had now become a fi?e art were, together with Mr. Best and hIS scenery, responsible for the realism which is now so much a part of all modern competitions. Lastly, he wished to thank the press for the publicity they were always so ready to give to the movement. In presenting the trophies Mr. Parshall said, 'I thank you for the great honour you have bestowed upon the Association and particularly upon me, by inviting me t~ present these trophies. The work of this Centre has always been a source of great encour:agement to us at Headquarters. My WIfe and I very much appreciate the

very wonderful reception you have accorded

~s today.' He could not resist the temptatt~:>n to Joke abol:lt the name which had been

gIven to tpe ratlway station on the setAlka-whlch, he felt certain, must have ~ee~ overlooke~ by tbe B.T.e. The 'Alka lIne h~d provlded an acid test for the competItors. He emphasized the need of a knowl~dge of first aid by all those engaged 10 transport, for they were the first to be ~sked to help in emergencies by the travelllOg public. He congratulated the teams, not only the winners, but all the others who had won through the Regionals to reach the Finals that day. 'Thank you' he concluded, 'for bearing with me.' ' Dr. Norman, whose work for the London Transport Ambulance Centre is so we.ll-known, expressed the pleasure it had gIven them to see Mr. Parshall with them, together with Mrs. (Dr.) Parsball whose presence and comments had been ~ gr.eat encouragement to them all. 'We wJlI not only maintain the standard' ~on<?lud~d Dr. Norman, ' but we will push It stdl hjgher.' Ald. S. Part, Chairman of the LIverpool Transport Committee thanked all who had contributed to th~ success of the. event, and especially referred to the receptIOn and facilities which had been extended by London Transport. In replying, the chairman said, 'I hope we shall be the hosts next year.' Of the many who had attended that day to support the movement we noted repres~ntatI.ves from Barton, Birmingham, Cardiff Clty, Coventry Ci~y, Edir:burgh City, H.uddersfield . Corporat~on , Leicesler City, Liverpoo~ CIty, Nottmgham City, Plymouth CIty, West Bromwich Corporation Wolverhampton Corporation and Londo~ Transport Authorities, Midland Red and Western Welsh. Dr. J. v. Braithwaite Medical Officer, Liverpool Transport, with whom .we had a long chat, is largely responsIble for the successes of the Liverpool teams.

British Railways International First Aid Finals This ~ompetition . i.s to perpetuate the reglOnal competItIOns which were interrupted by the nationalisation of the railways, and is conducted on a ' side' basis the winning side, England and Wales Scotland being declared the winner on the cumulative team marks gained. The England and Wales side consists of the ~inning team in the women's competition In one Region and the winning mens' teams In each of the other four Regions. The t~ams from Scotland are the winning team 10 the women's competition and the four winning teams in the men's finals. The competition was held in the Porchester Halls, London, and attracted a large and interested audience. The team test and one dual test were characterislic ' railway' tests, whilst the second dual test was an industrial one. The tests were the same for both men and women.

Team Test, set and judged by Dr. E. J. Selby, O .B.E., of London: A tramp, who has 'dossed' for the night in a wagon in the shunting yard, suddenly

realizes that it is moving, and attempts to clamber out of the back. In doing so be is trapped between the wagon and the stop block. Injuries: Simple fracture of both femurs compound fracture of right scapula, bruis~ on forehead, severe nerve shock. Dual Practical Tests, set and judged by Drs. C. T. Newnham, of London, and J. Rodger Sutherland, of Glasgow: os. I and 2, train passengers, are called by the dining-car conductor to attend to a patient who has slipped and fallen to the ground. Injuries: Simple fracture of right clavicle, strained (right) calf muscle, nerve shock. Nos. 3 and 4 are called to a sawmill to attend to an injured workman. Injuries: Hernia (left), dislocated (left) shoulder, splinter of wood penetrating left lung. Oral tests were conducted in private. It has been the custom [or each Region in turn to act as host and to organize the International Competition, and tbis year the privilege fell to the Western Region .

The .pres en tation ceremony, therefore, was preSIded over by K. W. e. Grand, Esq., General Manager, British Railways, Western Region. In opening the proceedings Mr. Grand stated tbat this was tbe first time that he had had the pleasure of attending the Competition, owing to unforeseen circumstances, but he sincerely hoped that it The Newcastle Centra] Team in action. They came fourth.

FIRST AID & NUR SING, SEPTEMBER/OCTOBER 1956

Competitions would not be the last. He explained that the International was a survival of an old custom, but, owing to nationalisation, its composition had had to be changed. At this stage the results were announced: ENGLA1\TQ A1\TQ WALES 1. Worksop 2. Lancing No. 1 ... 3. St. Pancras Goods

4. Newcastle Central 5. Newton Abbot (Women)

Total SCOTLAND 1. Motherwell 2. Glasgow (Women) 3. Perth 4. Bridgeton 5. Dundee West

420~

407

395t 370 352~·

J ,945~

415 387 385,} 370~

328 Total

1,885t

The winning side was, therefore, England and Wales. Mr. Grand then extended a cordial welcome to Mr. and Mrs. Stewart. He also wished to thank the St. John Ambulance Association for all they had done for the movement, and they were pleased to have with them that day Mr. Horace F. Parshall, T.D., M.A. (Oxon.), the DirectorGeneral of the Association. The chaimlan also paid tribute to the general managers of all the other Regions who were all so well aware of the value of a first aid training. There were, also, many others he would like to thank, but it would be impossible to en umerate them all. Mrs. Grand, in response to an invitation from the chair, then presented the Challenge Trophy to the winning team and certificates to the captains of the leading English (Welsh) and Scottish teams. Before resuming her seat Mrs. Grand received a beautiful bouquet. Mr. Stewart, Assistant General Manager, Scottish Region, proposed a vote of thanks to all those who had contributed to the success of the event, but mentioned especially the doctors who had so readily offered their time and skill to judge the competition. He paid a high tribute to the work of Mr. J. A. Martin, their wellknown secretary of the Western Region Ambulance Centre, who had been responsible for the arrangements, and they must not forget the 'patients', make-up artists, stewards, timekeepers and all who made up the great army of helpers. He could not specify them all for there were so many involved. Dr. Selby, on behalf of his colleagues as well as himself, made some valuable comments on the competition, stating that they had found the standard high. However he laid particular emphasis on the need fo; observation, and referred to the team test in which there was a lovely blanket hanging over the side of the wagon, yet nearly all the teams ignored this and sent messengers all over the place to obtain blankets. They must cultivate observation. A vote of thanks to Mrs. Grand, who was described as 'the first lady in the Western Region,' and to Mr. Grand for so many years of interest in first aid-he is a Serving Brother of the Order-brought to a close a most successful event,

Local Authority Fire Brigades First Aid Finals Mr. George Craft, the well-known st. John Ambulance Association competition secretary must have felt his palms tingling, indicating that he would be going on strange ground, for he had to travel to Hastings in order to organize this competition, which was held under the auspices of the St. John Ambulance Association in Hastings' famous White Rock Pavilion, just 64 miles, 898t yards (we like to be meticulously exact!) from his own Headquarters. Despite the difficulties, however, presented by the distance from his beloved Porchester Halls, the event proved an unqualified success. Eight teams competed for the St. John the Baptiste Trophy and plaques presented by the St. John Ambulance Association, each being the winner in one of the eight Districts into which the country is divided for the purpose of fire protection administration. Team Test, set and judged by Dr. D. D. Towle, of London: The members of the team are examining the fire appliances in the White Rock Pavilion when they are called to attend to an electrician who has fail en from a high ladder whilst engagc-d in fixing light bulbs under the roof. Injuries: Fractured (left) scapula, fractured (left) humerus, bruising on left side of chest, bruising over left mastoid region, flesh wound, right buttock, caused by small screwdriver in hip pocket, with slight bleeding until screwdriver is removed, shock. Dual Practical Test<:, set and judged by Dr. S. R. Matthews, of Crawley: The scene for both tests is set in the Long Bar of the White Rock Pavilion. Nos. 1 and 4 are called to give assistance to a customer who has collapsed. Injuries: Apoplexy, simple fracture of right foreaml. Nos. 2 and 3 have to aHend to the barman who, whilst carrying a heavy crate of beer, dropped the crate and fell on his outstretched hand. Injuries: Abdominal hernia, simple fracture of left clavicle, rerve shock. The proceedings were opened by the Presiding Officer, C. P. Kitchin, Esq., Chief Fire Officer, Borough of Hastings Fire Brigade, who introduced and welcomed the Mayor and Mayoress of Hastings, Ald. F. T. Hussey, J .P., and Mrs. Hussey. His Worship extended a cordial welcome to all, referring, with regret, to the fact that the Annual Conference of Fire Officers was drawing to a close. He welcomed Mr. Horace F. Parshall, T.D., M.A. (Oxon.), the Director-General of the St. John Ambulance Association, Mr. H. M. Smith, C.B.E., H.M. Inspector of Fire Services, Mr. A. B. Craig, O.B.E., Fire-master, South Eastern Area, Scotland, and President of the Chief Fire Officers' Association, and Mr. George Craft, the S.l.A.A. competition secretary, who was organizing the competition that day. Competitions like this, he said, contributed so much to efficiency in the movement. The competition, he declared, was now commencing.

After the conclusion of the tests there was a short interval for tea, after which Mr. Kitchin again presided, this time at the presentation ceremony, expressing his pleasure at the attendance of the President of the Sussex County Branch of the S.J.A.A., Sir Harry C. S.i nderson, K.B.E., C.M.G., M.V.O., O.SU., M.D., F.R.C. P. (E). Mr. Craft then announced the results: ]. City and Cou nty of Bristol 334 (winning the St. John the Baptiste Trophy) 326 2. County of Surrey 316 3. City of Kingston-upon-Hull 4. County Borough of Middles314 brough ... 308 5. City of Cardiff ... 30216. City of Binningham 293 7. County of Isle of Ely 255 8. County Borough of Preston After the announcement of the results the judges were asked to comment upon the competition, and Dr. Towle opened the ball. He said that, as he had only a few minutes to speak, he would have to be brutal, bUl he believed that his hearers would appreciate this. Dr. Towle pointed out that the victim in the team test had fallen from a great height, and this must almost inevitably result in some bruising, which some of the competitors ignored. The screwdriver in the man's pocket should have prompted them to seek for any damage resulting, and this would have led to the discovery of the haemorrhage. A more thorough examination of the head would have revealed the bruising over the mastoid region, suggesting a possible cause of concussion. 'I wanted you to tell me why the man was unconscious,' he said. He pointed out that, when they came to examine their marking sheets afterwards, they would find that no marks had been allotted for approach, blanketing or stretcher work, He wanted them to concentrate more upon diagnosis. They should have tried to realize that they were four men doing first aid and not members of a fire brigade. It should be necessary to go over the patient once only if this is done thoroughly. They can then get him off their hands quickly. The standard was generally good, but he offered words of encouragement to the two teams of beginners. Dr. Matthews said that he was in complete agreement with all that Dr. Towle had said, and it left him lillIe to say, for the remarks had fitted his competitors as well. The tests he had set were comparatively simple, and those who had fallen down on them had done so on first principles. Like the previous speaker, he urged them to concentrate upon diagnosis. Some of the competitors had been inclined to scamp this. On the whole, however, he had fou nd the sta ndard good, 'Good luck to you a ll,' he concluded. In reply to the chairman's invitation, Mr. Parshall said that once again it was his p leasure to occupy the platform o n t he occasion of this important competition. He had seen them grow during the six years they had been organized. 'We who

Continued at bottom oj next page

F TR ST ATD & NURSING, SEPTEMBER /OCTOBE R 1956

From a seat in the audience Some Random (and Provocative) Comments on the Competitions R ailways I nterna tional Traction must be maintained continuously. Bandaging was not always orthodox although, perhaps, effective. ' Bandages must be applied in correct order-there is a reason for everything. Name and address could have waited. Most important jobs should be done first. D on't put leading questions. Removal of clothing was sometimes carried out rather roughly. When will blanketing be standardized? , We're first aiders '-near the end of the test. Were all those technical details to the inspector, who was not a firsl aider, necessary for the 'phone message? Shock should be treated first, not as an afterthought. We did not see a single tape measure. The significance of the' sucking' wound was not always fully appreciated. It should have been covered without delay. The judge doesn't want to hear the textbook recited verbatim. He knows it as well as you do. One leader should have been provided with a soap box in Hyde Park-or Lochee Park. 'Are you a first aider?' 'No.' 'Then you should join our class.' One team would have done better with the eye OFF the clock. We thoroughly enjoyed the shunting yard continuo. How many ignore the classic signs of fractured clavicle. These should provide an immediate clue. Don't be afraid to stick your knee into his back (clavicle). That bandage must be tight. Some forgot to loosen braces-very important. , You can't move it and I can't move it! ' (Dislocation). Poor devil! One competitor used the F.A. box as a support-then couldn't get to the contents!

Fi re Brigades 1t is not necessary to count the pulse aloud. 'Do all these things rather than say them '-judge. That arm came in for some pretty rough handling.

, Get two cups of tea, one for the gentleman and one for yourself.' The importance of 'history' is being more and more appreciated. The ju~~~ mi~ht have been less helpful. Our cntlclsm In the March'April number of the 'attack' approach has certainly produced results. H ow they managed to get that screwed-up b lanket u nder was a miracle. Those d irty overalls were hardly suitable as a covering for an open wound. , Has the stretcher been tested?' Don't trust to bystanders. Tried to interest the patient-football, pools, etc. Excellent. Diagnosis was good in some cases but not in the right order. ' Congratulations to the Birmingham leader for his adaptation of orthodox blanketing. Bystanders should not anticipate detailed instructions from competitors . They are supposed to know nothing. Was it necessary to remove the ladders? They constituted no further danger. This sometimes become~ a fetish. Judges should not furnish information which should be obtained by physical exami nation. D on't ask a shocked patient IF he wants a cup of tea. Give it to him. D on't put the cigarette in your own mouth first. Where's your hygiene training? No need for detailed instructions if they know their stretcher drill. It is a long time since we saw the foreand-aft lift used. These were firemen this time. 'We send a tactful message.' Well, what was the message? The hernia should have given the most pain . Groaning should have been continuous. National Road Passenger T ransport One competitor was trembling like an aspen leaf. R aised the leg AFTER bandaging patella. Again we saw that tea getting cold. Padding pushed under ankle (patella) after completion of splinting is absolutely useless. Fancy blankets with temperature well up in the 70s! Poor devil!

Those Glass Hot-Water Bottles ! From our seat in the audience we have frequently criticized the growing tendency to use ordinary glass bottles, such as might be used for beer, mineral waters or squashes, as su bstitutes for hot-water bottles, on the grounds that this practice prese nts more than an element of risk. In our discLlssions of this subject with various judges we found a diversity of opinion, some agreeing with our argument whilst others expressed disagreement. We decided, therefore, to submit the question to Prof. R . W. Douglas, D.Sc., F.ln LP., F.S.G.T., professor of glass technology at Sheffield University, who replies as follows:

'The amount of them1al shock which a glass container will withstand depends upon the type of glass of which it is made and the shape of the container. Many bottles used for beer, soft beverages and the like are not designed to withstand boiling water, and it would not be wise to recommend generally the use of glass bottles as emergency hot-water bottles. It is, of course, quite possible to make a glass bottJe specially to withstand such thermal shock.' We trust that the advice of such an author ity as Prof. Douglas will dispose, once and for all, of this vexed quest ion, and we are most grateful to him.

9 Patient had to ask for smelling salts.

T~e figure of eight was the only bandage

servmg any useful purpose. That teapot on the floor. It was a mIracle how it escaped being kicked over Don't turn the haversack out. Tak~ only what is required. Why strap both ankles when only one was sprained? We have not seen much of the 'nuisance' lately. This is a pity. . If that lung wasn't punctured by the tIme they'd finished with him we'll eat our hat-if we wore one. Our notes on ' attack' approach appear to have had effect. Much time would be saved if competitors knew their haversack thoroughly, There was no doubt about the thoroughness of the examination of the patient by one team. They nearly stripped him . It was enlightening to overhear the intelligent comments by some of the cadet spectators. Very few teams think to obtain witnesses. N.H.S.R. (Mobile Units)

Would it not have been preferable to switch off music during tests? It was distracting to both competitors and spectators. We would like to have heard the judges' comments. Should not the haemoptysis case have been transported on a stretcher instead of being made to walk? One team used the' two handkerchief' instead of the' barrel.' We agree. It is more effective. Surely the M.O. could have been employed upon more technical duties than placing notice boards. We liked those wheeled baskets and cases. One team might have kept the floor more clear of litter.

Local Authority Competition- Continued have been in the movement for many years,' he said, . think we know something about first aid, but watching competitions I ike this shows us how much there is still to learn.' He went on to acknowledge the debt they owed to the Hastings Fire Brigade, the Hastings Police, the local S.J.A.B. Divisions and particularly to Mrs. Fraser, the energetic hon. secretary. In conclusion he congratulated all the teams, reminding the audience how closely the competition had been fought. Mr. Parshall then presented to the winning team the St. John the Baptiste Trophy and plaques, which had been presented for competition by the St. John Ambulance Association. A plaque was also presented to the captain of the Great Yarmouth team, the winners of the competition in 1955. Mr. Parshall was thanked by the chairman on behalf of all present. Proposing a vote of thanks to Mr. Parshall, Mr. Smith said, ' We shall not be happy until every member of the fire service holds a first aid certificate.' Mr. Craig aid,' This is my first appearance, but T have been very much impres~ed by the large numbe~ of personnel wh<? give their time to learmng what to do III an emergency.' He wished to second the vote of thanks which had been proposed to all who had helped to make the event a succes ,

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

Beaders~

queries Answered by Dr. A. D. Belilios

inations and future attacks may decide the issue. C. G. M. (Chelsea) writes:In the S.l.A.A. first aid manual, overlying an infant is given as an example of smothering. Would you be kind enough to arrange for tMs cause to be explained. Answer It means more or less what it says,

C. P. H. (Bournemouth) writes:What is the reason for the instruc- . tion given in the SJ.A.A. manual (p. 131, paragraph 2) whereby the patient is instructed to breathe out before the knots of the bandages round his chest are tied.

i.e. lying on or over an infant to such an extent that it cannot breathe. It may occur if the infant is in the same bed as an adult or older child but nowadays it is uncommon since babies have almost always their own cots. Almost the same thing has occurred through c?, ts going to sleep over an infant's face.

Answer

This is a most important point. The pain caused by broken ribs is aggravated by movement and this of course includes breathing. By tying off the bandages while the patient's chest is deflated firmer support is obtained and the injured ribs are immobilized as far as possible. F. M. H. (Worcester) writes:I was involved in a funny case recently. My next door neighbour asked me to help him with his wife who had woken him up by her restlessness in bed. She could not be wakened and was lying on her side with her knees drawn up. There was a damp patch on her pillo\v as if fluid had come from her mouth. A doctor was called but by the time he arrived the lady was awake and appeared quite normal except that she seemed a little confused when she spoke. The doctor could not give an opinion as to what had been wrong with hershe is a healthy woman otherwise. I wonder if Dr. Belilios could make any suggestions? Answer

Very difficult as there is not enough to go on. But I am suspicious from your account that she may have had an epileptic fit in her sleep. Her husband may not have heard the initial moan if it occurred and the restlessness that woke him up may have been convulsions. Some people do have what is called nocturnal epilepsy; special exam-

M. E. F. (Epping) writes:I have heard of people suffering from varicose veins which burst and cause severe bleeding. Could you give me some idea of the nature of this condition and the treatment to undertake. Answer

These usually occu r in the legs and the veins appear swollen and twisted with bulges along their course. The cause of the trouble is that the valves in the veins no longer work satisfactorily and permit blood to flow in the wrong direction, e.g. down towards the feet instead of always towards the heart. If a vein bursts through the skin, there is profuse haemorrhage and the patient may collapse. The treatment is to apply the general rules for Nounds accompamed by severe haemorrhage, paying particular attention to elevating the limb. F. B. (Birkenhead) writes:On reading about the competWons in the July/August edition of First Aid & Nursing, I noticed that toxic shock is mentioned. My query is this, would toxic shock be present from injuries as set for Ministry of Supply Finals, Men's Test, Nos. 2-3. Also, could a first aider sincerely tell the difference between toxic shock and shock. I have enjoyed reading your articles over a long period now, but this is the

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

first time I have bothered you with a query.

•

Answer

You haven't bothered me at all. I like to receive these queries. I think in fact the test was tricky, but you must be prepared for 'catches.' The information given in the journal is really insufficient to go on but, in my opinion, if the accident had recently occurred, it was rather early for toxic shock to have begun. I also feel that it is very difficult for a first-aider to distinguish between the various varieties of shock.

FllRACIN BRAND OF

nitrofurazone

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1. B. S. (Slough) writes:-

One of the workers in our factory has been away for some time \vith a complaint called teno-synovitis. I should be very grateful for some information on this subject.

Infected lesions treated with 'Furacin'

•

often heal surprisingly quickly. For' Fura-

•

Answer

cin' has an antibacterial potency of anti-

Many muscles in the body are spindle-shaped and taper away at either end forming tendons which are made of strong fibrous tissue and attach the muscles to the bones. You can feel these tendons like cords under the skin at the front of the wrist, back of the knee and elsewhere. These tendons are themselves surrounded by some tissue called the tendon sheath. Inflammation in the sheath of a tendon is called teno-synovitis. It results in pain particularly when the affected muscle is used and often a creab ng vibration like crepitus can be felt over the tendon.

•

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biotic calibre, and is remarkable for its harmlessness to human tissue. Hospital and

industrial experience has

shown that this potent nitrofuran gives exceptionally happy

results in

infecteci

wounds, burns, ulcers, bedsores, etc.

J. C. B. (Torquay) writes : In several first aid conditions e.g. apoplexy, fractured base of the skull, etc., the pupils are often unequal. Can you explain why this inequality should occur?

•

• • • • • • •

• • • • • • • • • • • • •

Answer

This is generally due to interference with the nerve supply of the muscles which control the size of the iris. Two nerves are involved, the third cranial and the sympathetic, the former tending to contract the pupil and the latter to dilate it so that a balance is preserved. If one of these nerves is damaged by injury or disease, the other exerts its full effect and thus produces inequality.

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FIRST ATD & NURSING, SEPTEMBER /OCTOBER 1956

Head First EXCEPT in a few well defined conditions, known to the first aider, it is customary to carry stretcher cases head first. It is also usual to load a stretcher into transport with the head nearest to the driver's cabin. In some hospit als it is considered very bad form to carry a stretcher case into a ward feet first and ward sisters have been known to make very caustic comment on such a practice. E ven more caustic comment is made if attempts are made to carry a p atient out of a ward feet first. The reasons for th is traditional practice are complicated but there are, of course, numerous technical reasons which can be given to justify it. The journey is made less bumpy for the patient since the head is well away from the back axle ; the front of the vehicle is less rocky than the back; the bearer at the back can watch the patient's face for signs of changes in condition. These are some of them. There are, however, an equal number of reasons why a stretcher case should be carried feet first. The patient can see where he is going and is thus gi ven extra confidence, the bearer at the back is more likely to be steady since he is not concerned with direction, etc. The tradition of carrying head first has probably less to do with technical considerations than with the tradition of carrying the dead feet first, and the necessity on occasions to be able to distinguish qwckly between living and the dead. It has also something to do with the necessity to assure the patient that he is not given up for dead. The reasons why the dead are carried feet first are closely connected with burial custom. Position of the dead at burial varies greatly from country to country, from tightly contracted to fully extended, the former being associated with the more primitive, and the latter with more sophisticated societies. Some religions give very specific instructions about orientation of the dead at burial; some must face the sunrise, some must look to the north. Until the Christian era, orientation in England varied greatly. Christianity taught, however, that the feet of the dead should be towards the east, when they would hasten at the sound of the Last Trumpet. The position is, in general, the same today. Burials conducted at sea are carried out in such a manner that the dead man goes overboard feet first , owing to the weights sewn into the canvas coffin. The term' feet first ' is C]uite common in the English language and those sisters who did not wish to see patients leave their wards in this manner are influenced by the feeling that only the dead are carried feet first. Fortunately knowledge and common sense are combining to allow patients to be carried in the way most suitable to the injuries they have sustained, but the process would be accelerated if those who greet the carriers of stretchers at hospitals, either in the hall or on the ward could eradicate from their minds the prejudice of archaic teaching. Editor's Note : The recognised technique today is : i/ the patient is consciollS the practice is to ask the patient which he pre/ers: head or feet first. These are the instructions given to first aiders to-day and in competitions marks are actually allowed/or this On the marking sheets.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

* First-Aider~s Crossmord No. 25 Compiled by W. A. Potter

Bedford The ·one-make' fleet

Lomas" B type" ambulance on Bedford A2 ambulance chassis. Prices from . . . £1,504.2. 6.

Lom e.s from £71 2 plus £132 19.10 P.T.

It pay to standardise on ACROSS

27.

Scandal spreader. Is G.P. so different? 5. A fracture here may easily become open by careles5. treatment ... 9. Robber who must have a degree first. . . 10. . .. and another who is mostly angry 11. Senseless in a point 12. Plan for the future 14. Lineofcancer . . . 15. Taken into hospital 16 . Railway with nice change en route 17. Has had all bones removed 19. Fabulous animals with fins for a tail... 21. Serious always between beginning and termination 22. Boards for doctors') 23. Bacchus's long eared servant . .. 24. Baby needs no. 25for this! ... 25. Do not use in corrosive poisoning

(6)

28.

Like promises, the first-aider does not break these. .. Ambition for student nurse

(8) (6)

(8) (6) (6) (5) (6)

(6) (8)

(6) (6) (8) (6) (6) (5) (6) (6)

DOWN 2. 3.

4. 5. 6. 7. 8. 13 .

18 . 19. 20. 26.

Eggs from polio vaccine (3) The first-aider 's medical knowledge is needed (6, 9) He is not always so in the waitingroom (7) Abraded red caps (7) Pie must give impulse... (7) The result of playing with fire? (4,4, 7) Failure may lead to marasmus (11) Alternative to sunlight as rickets prophylactic ... (3, 5, 3) Support, perhaps for rocking stretcher (7) Gotslitatentrancetotrachea (7) Force upon the mind (7) Biceps has its own remedy for a strai n (3)

SOLUTION TO CROSSWORD No. 24 ACROSS

DOWN

1, As thin as a rake; 9, Reluctant; 10, Tripe; II, Sits up; 12, Fringes; ]5, Drip; 16, Heals; 17, Scan; 19, Nude; 20, Ebony; 21, Clot; 24, Impasse; 26, Reason; 29, Colon ; 30, In patient; 31 , Trace elements.

2, Split mind; 3, Hiccup; 4, Near; 5, Suture ljne; 6, Rating; 7, Knife; 8, Wen; 9, Resident; 13, Derbyshire; 14, Instinct; 18, Cold Sweat; 22, Tannic ; 23, Nettle; 25, Malar ; 27, Ice; 28, Apse,

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FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

A Revised B.R.C.S. Textbook years ago a young married wo~an SOME came into casualty for a re-dressmg. It happened to be a very busy morning, for there appeared to be a much larger nun: ber of patients than usual, and It. was ObVIOUS that she would have to Walt some considerable time before she could receive attention. Noticing that she appeared to be exhibiting considerable agitation I went over to her to try to ascertain the cause of her obvious anxiety, and discovered that she must be home by a certain time in order to give her baby its regular feed. Needless to say, she was allowed to 'jump the queue' and in a short time was happily on her w~y back to attend to her infant charge. I have mentioned this incident in order to emphasize the a~vance in knowledge wh!ch has been made 10 recent years concermng the management of young children. At that time the child-and also the adultwas regarded as a piece of mechanism which had to be oiled and fuelled at regular intervals and it was believed, more or less, that any'neglect of this fixed routine would result in the development of some mechanical defect. Today it is realized that no such uniformity exists in the mechanisms of various human organisms, that no two are exactly alike and, therefore, that each must be studied separately and the appropriate individual treatment given. This important point has been brought out most clearly in the new edi tion of the British Red Cross Society's manual on the care of the child, which has been sent to me for review. Its title, I note, has been changed from' Infant and Child Welfare Manual' to ' Maternal and Child Welfare Manual' in recognition of the fact that the health and welfare of the child cannot be considered apart from that of the mother, another example of the advance of our knowledge of scientific child welfare. Unlike most works on infant care, this manual anticipates the arrival of the little stranger by discussing the health and habits of the mother during those anxious prenatal months of preparation, offering most valuable advice, some details of which

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

Northern Newfoundland's First Ambulance

COSTIVE

CHARACTER

A motor ambulance, the first ever to be

appear for the first time in a popular treatise. In a short but clearly-written chapter the ·anatomy and physiology of the female pelvis is fully described and illustrated, and a study of these pages will help the student to explain to the young mothers many of those problems which often trouble them, but which they hesitate to present to those who could help them. The information will also help the student to appreciate why many of the old-fashioned beliefs have now been discarded by modern obstetricians and gynaecologists. It should also be read and studied by ambulance attendants, both female and male, and others who may be called upon at any time to assist in emergency. The chapter concludes with some valuable advice upon hygiene. The subject of infant dietetics is dealt with in a clear and commonsense manner, and revision of the chapter on this subject in the B.R.C.S. 'Nursing' manual should be undertaken simultaneously. Figures, often considered 'dry', are sometimes passed over as unimportant, but those governing the development of the child from birth to the age of five years, quoted in chapter IX, should be studied carefully, for they will provide a very accurate indication as to whether the child's progress is normal or whether medical attention should be drawn to any apparent variation . The question of clothing has not been overlooked, and some valuable hints on this will be found in chapters X and XI, as well as some The psychological hints on training. manual concludes with good advice upon sick and accident nursing of children. Set in a type which entails no strain upon sight and carrying a beautiful photograph of the Queen, reproduced by permission of Her Majesty, and with a foreword by Lady Limerick, Drs. Dennis Geffen and Susan M. Tracy are to be congratulated upon the production of a text-book which should prove a valuable contribution to the training given by the British Red Cross Society. It is a good six shillingsworth. F.CR.

used in Northern Newfoundland, has been presented to the Grenfell Mission by The Bowater Paper Corporation. The ambulance, a vehicle of rugged construction and four-wheel drive, has a Land Rover chassis, and will be particularly suitable for use along the forest trails and rough roads of northern Newfoundland. It will be instrumental in easing the often difficult task in such wild and lonely territory, of bringing sick and injured people to hospital as quickly and as comfortably as possible. Until recently, there were no roads from the town of St. Anthony, where the Mission has its Headquarters hospital. Now the Government of Newfoundland has embarked on an extensive programme of road building, which will link up St. Anthony with the many small coastal settlements in northern Newfoundland. Areas served by the new ambulance will include Hare Bay and st. Anthony, on the East coast, Hawkes Bay, River of Ponds and St. Genevieve in the West-all key points in the logging and forest conservation operations so vital to the paper industry. Many of Bowater's employees in the northern forests already owe their lives to the work of the doctors and nurses of the Grenfell Mission and of the hospital at St. Anthony founded by Sir Wilfred Grenfell in 1892. Here, too, miracles have been performed in the fight against tuberculosis, which at one time was the gravest problem, endangering the health of hundreds who had no hope of medical attention. Today, St. Anthony has a fifty-bed Sanatorium, and its surgeons perform operations comparable with those in the world's leading chest hospitals . Built on the four-wheel drive Land Rover chassis by Pilchers of Wimbledon, the ambulance incorporates the latest aluminium alloy techniques to achieve the strength and lightness necessary for work in territories where roads are poor or non-existent. Windscreens are of tinted glass to prevent snow glare.

Ambulance Coachwork

, You and Your Operation'

Kennings Ltd. (Coachwork Section), Clay Cross, Derbyshire, have produced a fine illustrated catalogue dealing with their range of coachwork for a variety of ambulance types. Included in the catalogue are diagrams showing internal layout.

This is the title of a 7/6 book by B. N. Brooke, published by Faber & Faber Ltd., 24 Russell Square, W.C.1. The book follows a journey through the hospital and provides interesting information for all, and should allay the fears of those who are about to undergo an operation.

Remember Edith? ••. she's still as edentulous as ever, for her lower alveoli havt absorbed to the point where nothing will seat.

Notes

Miscellaneous Advertisements should be sent to First Aid & Nursinf. 32 Flnsbury Square. Lond:>n, E.C.2. Rate 4d. per word, minimum 6s.

Box numbers Is. ex~ra.

SCENT CARDS. 250 17 /6, 1,000 52 /6. Tickets, Printed Pencils, Memos. Samples free.-TICES, ) I Oaklands Grove, London, W.12.

s. J. A. B.

Badge Wall Shields, 26s. 6d. S. J . A. B. Gold cased crested Cuff Links, 50s. S.J.A.B. Badge Ladies' Brooches, 21s., Trophy Shields supplied. Medal ribbons 9d. each on buckram for sewing on uniforms, Is. each ribbon if mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for leaflets. - Montague Jeffery, Outfitter, St. Giles Street, Northampton.

E.S.P. TRAINING MODELS Is your Unit equipped with The ESP MINIATURE SKELETON? 26" high, scale model of the human skeleton. Write now for details of this and other valuable training aids including: SCULPTURED SKELETON (FULL SIZE) MINIATURE DISSECTIBLE TORSO MOTHERCRAFT DOLL HUMAN EYE HEART, EAR, ETC., ETC. Prompt attention to all enquiries. Illustrated brochure {rom

Sole Manufacturers;

may be for her bowels.

Tel: Downland 2402

But both she and her constipation are

seen in the surgery far less often, for now she takes a small daily dose of PETROLAGAR Plain (blue label). PETROLAGA R is composed of 25 % mineral oil emulsified with certain bulk and madefaction-retaining substances.

Mixing

intimately with the intestinal contents, it helps to make up the defi ciency in moisture and mass, restoring a

natural

consistency P elrolagar Em."sion is provided in Iwo varieties 10 meet individual needs. Plain. for the average case of simple and spastic conslipation and wilh Phenolphthalein for obstinale and chronic cases.

to the freces.

PETROLAGAR

Supplied ill 8-ollllce and [6-ounce bOllles.

(lfjetA'J The word' P etro/agar' is the registered trade mark of

JOHN vVYETH & BROTHER LIMITED , CLIFTO I

Nineteenth Edition. Completely revised. 261st thousand . 286 pp., 286 illustrations, some coloured, 6s. 6d., post 4d. WARWICK AND TUNSTALL'S

FIRST

AID

TO THE INJURED AND SICK Edited by A. P. GORHAM, M.B ., Ch.B., M.R.C.S .

Police Surgeon. City and County of Bristol

FIRST AID' WALL DIAGRAMS 26 X 40 in. A-G H-J K, L M, N 0, P Q, R S, T

Anatomy and physiology. The triangular bandage. The roller bandage . H;emorrhage and wounds. Dislocations and fractures. Transport . Artificial respiration.

Single Sheets : Linen - 7s., plus postage. Paper - 55., plus postage. Set of 20, on Roller : Linen - 150s., post free. Paper -1005 .• post free. The British Red Cross Society have specially adopted a set of 6 sheets, A, D, M, N, 0, P, which can be supplied on linen with fittings for the special price of 50s., plus postage.

EDUCATIONAL & SCIENTIFIC PLASTICS LTD. 71 Brighton Road, HOOley, Coulsdon, Surrey

So she avoids

like the plague any roughage foods, no matter how good they

First Aid Films Two films entitled ' Burns and their Treatment' and 'Training a Nursery Nurse' have been produced by Film Strip Producers and Distributors, 23 Denmark Place, London, W.C2.

JOHN WRIGHT & SONS LTD.i BRISTOL

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~~~~ ~ri~~;tC;;f-~7sti~~~ . case, makes special mention of the Sanitary Chair. This article, in which he welcomes its introduction, quotes us as the suppliers.

~ " I could not, however, escape the use of a bedpan, and this antiquated instrument, which has been hated by so many patients, and the drawbacks ' of which were greatly aggravated in my case, was one of the penances of my life. I am glad to know that it is already being displaced in many of our geriatric hospitals by ambulancy and by the sanitary chair." With acknowledgments to ' The LANCET, ' July 7th, 1956.

Please write for details

G. McLOUGHLIN & CO. LTD. Dept. L.F.A., VICTORIA WORKS, OLDHAM RD., Tel: ROCHDALE, LANCS. Rochdale 48977

FIRST A[D &

URSI G, SEPTEMBER .! OCTOBER 1956

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1956

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You can order your St. John Ambulance Uniform with confi~ence, knowing that every detail will be in accordance with regulatlons. We shall be pleased to send full details upon request.

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BAILLIERE BOOKS';: FOR FIRST AlDERS A HANDBOOK OF

ELEMENTARY NURSING Arthur D. BeliJios, M.B. , B.S., D .P.H., and Dorothea Duncan-Johnstone, S.R.N.

THE HOUSE FOR

HUMAN SKELETONS Waterproof First Aid Cn:.ssings are intended for use when a wound is exposed to water, or contamination from oil, dirt etc ., and where necessitated by hygienic requirements. Illustrated is our most popular assortment of such dressings (Adaptopruf No . M207) consisting of 114 adhesive plasters of five different sizes. Each has a dressing pad of soothing, quick healing Euflavine, a most effective medicament equally for woun ds and burns. Whenever a waterproof plaster is not essential we recommend Adaptoplast First Aid Dressings be used.

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This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. It describes in simpJe language the basic principles and procedures that underlie the science of nursing, and contains brief descriptions of the more common diseases, with general notes on the nursing required in each case. A complete chapter is devoted to the subject of home nursing, and the whole book provides for every first aider the essentials of nursing in a handy yet comprehensive form.

With 314 pages and 57 drawings 8s.6d. Postage 9d.

BAILLIERE'S HANDBOOK OF

FIRST AID AND BANDAGI NG by Arthur D. Belilios, M.B ., B.S . , D.P.H., D. K. Mu]vany, M.S., M.B., F.R.C.S. , F.R.C.P.I., and Katharine F. Armstrong, S.R . . , S.C.M . First aid bOOKS, as a rule, confine themselves to injuries, e.g. fractures, wounds, burns, scalds, etc. This volume is far wider in scope. It covers medical conditions of all kinds, and much of the information is not to be found easiJy elsewhere. There are chapters on case-taking, medical causes of unconsciousness, internal haemorrhage. first aid in maternity cases, first aid in spinal injuries, asphyxia, industrial poisoning, the use of morphine. 'Undoubtedly the best of its kind.' Nursing Mirror. Fourth Edition. With 488 pages and 200 drawings. 8s. 6d. Postage 9d. Bailli~re, Tindall and Cox Ltd . 7-8 Henrietta Street OR

Dale. Reynolds and Co. Ltd. 32 Fi nsbury Sq uare

London. W.C.2

London, E.C.2

................ copy/ ies of A Handbook of Elementary Nursing Please send me { . A ·d d B d . ................ copy/ ies of FIrst I an an aging for which I enclose remittance of. ........ .. .............(Postage 9d. extra per volume.)

Bailliere, Tindall and Cox

Name .... ...... ............ ....................... .. ......... ...................................... ................................. .... . Address ...... ............................ ................................................................... ........ ................. .

A NEW ALL-METAL 2-STRETCHER AMBULANCE ON THE LAND ROVER I 07 in. W /B CHASSIS NOVEMBER/DECEMBER 1956

HIS up-to-date ambulance incorporates the latest aluminium alloy constructio n

T techniques to combine toughness with comfort, and has all the mobility an d tenacity afforded by a 4-wheel drive. The design provides for two stretchers and an attendant, one stretcher and three sitting cases, or six sitting cases.

Features include built-in wash basin with water supply, fully insulated body

SKIN INFECTIONS are primarily caused by Staphylococci, Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms.

PILCHERS

AMBULANCE & MOBILE UNIT BUILDERS

314 Kingston Road, Wimbledon, S.W.20 Telephone: LIBerty 2350 & 7058

•

47 High Path, London, S. W.19 Telephone: LIBerty 3507

bactericidal thus obviating the need, when not convenient, of changing the dressings every day. and numerous skin infections, ANTIPEOL is unquestionably the remedy. It is already in widespread use by the medical and nursing professions in many parts of the world. FOR CUTS, ABRASIONS, BOILS

for tropical use, and adequate locker accommodation. You are invited to apply for full details of Mobile Medical Units, Ambulances, etc., built to your particular requirements for service in any part of the world.

PRICE PlVEPENCE 3 6 per Annum Post Paid

ANTlPEOL is therefore

an essential component

for burns and scalds, ANTIPEOL OINTMENT is both non-adhesive and AS

TREATMENT

of eyery First Aid and

Nursing Kit.

Printed by HOWARD, ] ONES, ROBERTS & LEETE, Ltd., 26-28 Bury Street, St. Mary Axe, London, E.C.3, and published by the Propnetors. DALE, REYNOLDS & CO., Ltd., at 32 Pinsbury Square., London. E.C.2, to whom all communications should be addressed.

FIRST AID & NURSING, NOVEMBER/D ECEMBER 1956

First Aid &

PATENT

Nursing

"PORTLAND" AMBULANCE GEAR

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

Editor: Peter I. Craddock

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

A. Shows the two stretchers in position. 8. Shows the top stretcher lowered read y

This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.C.2, for tbe purpose of providing an informative technical service on first aid and nursing. We welcome C'ontri butions.

for loading. lllustrat{,s the same Gear wHh the top stretcher fr ame hinged dow n for use when onl y one st retcher case is carried. D. Shows the same posit ion as in "c " oruy wi t h cushions and back r est fit ted for convalescent cases.

November jDecember 1956

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

Plastic Lacerations and W ound s Diseases of the R espiratory System... 2 Revolutionary Advice on Secondary Sh ock Treatment 3 S.J.A.B. Surgeons' Conference 4 Casu alties Union News 7 Grand Prior's Trophies 8 Cas ualties Union Day 9 Brigadier T. Denis Daly 9 From a Seat in the A udience 12 Blood Grouping 12 Read ers' Q ueries 14 Sol ution to First Aider&' Crosswo~ 14

In this Issue

Full cotGIo~e of Ambulance Equipment No.7A wi/} be sent on requ ..:t.

~,---------------

65, WIGMORE STREET, LONDON, W.I 'Phone: WELbeck 0071 (late G REAT PORTLAND STREET)

BRITISH RED CROSS SOCIETY OFFICERS (MALE) TU N IC & TRO USERS

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A FTER considerable research in t he lab oratories of a modern plastics manufacturer, a revolutionary prod uct has opened up new possibilities in the field of injury simulation. The days are long past when personnel attend ing first aid classes receive verbal instruction regardi ng the supposed injuries and from which d iagnosis depended enti rely on mental gymnastics performed by the ind ividual. Now, patients are trained, and make-up of injuries is represented to a remarkable degree of accuracy ensuring complete agreement in the treatment of any given condition. Rightly enough, the national organisations lay stress on the imp ortance of such training, lack of which would create a first aid body excelling in theory, but severely deficient ill practical techniques . A number of first class books are availa ble and instructors deal comprehensively with the art of injury si mulation. Were they recorded the number of hours spent on this subject would reach astronomical fig ures. Time then, becomes of vital importance when science proves it possible, in mosl cases, to cispense completely with lengthy make-up and in the remainder, to provide such assistance that time in preparation is cut to a fraction. Here is a simple equation, with a given time of one hour. Preparation of casualty-one hour, time

remaining, no hours . If, however, the first aider used plastic wounds, equalling in every way the artistic results of the best men available, and can be applied in a matter of seconds, the equation would then be: preparation of casualty, including selection of wound-five minutes, extra time to be devoted to treatment-55 minutes! Such wound replicas are available from Browning's Laboratory & Supply Co. Ltd., 69 Aberdeen Street, Hull, marketed in a range of ] 6 remarkable reproductions, ranging from simple lacerations, through burns and blisters, to simple and compound fractures, in washable plastic. These are applied with adhesive and can be used over and over again, repeated use having no adverse effect on the form and appearance of the material. The laboratory does not claim to have answered all casualty simulation problems. Battle and civil defence casualties, for instance, are high on the research department's list, but results are encouraging. Local wound conditions, are, however, presented in a realistic manner and further reproductions are due for release in 1957. This new product obviously greatly assists in the element of realism which must be present in the training of all first aid personnel, otherwise efficiency in a time of crisis would be problematical.

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Do you know that • • '. Acetanilid, used extensively in proprietary headache powders, frequently gives the patient a dusky appearance by producing a toxic effect on the blood and interfering with its oxygen-carrying powers? Pliny once said 'Ma n is the only crea ture from whom blood flows at the nostrils '? The earthworm is believed to be the lowest creature to possess an organised nervous system? Oil from grease guns may penetrate the skin of the hands, causing sepsis and gangrene? Vision increases in accuracy in proportion to the intensity of the light up to a level of 2,000 foot-candles? The existence of tbe virus as an entity was demonstrated by Iwanowsky in 1892?

Last year, in commencing a report of an incident in which a cadet saved the life of a child by prompt and accurate applicatio? of artificial respiration, we asked, ']s It worth while training cadets?' We ~re reminded of this by a sentence :which appears in a letter from the B.B.C. 111 the course of some correspondence exchanged recently concerning a.' :first Aid Quiz,' and we therefore quote It lfi full:

, ... point out, however, that in former 'Children's Hour' quizzes, confined to members of the Red Cross and St. John only, the Jevel of answ.ering was so high that there was rarely, If ever, an opportunity of awarding other than full marks.' We are publishing this quotation as . we feel that it will prove most encouragl!lg, both to the cadets and to the great teachlfig organizations responsible.

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FIRST AID & NURSING, NOVEMBER/DECEMBER 1956

A Course in Elementary Medicine

Diseases of the Bespi,-ato,-y System

article in this new series THEonlastElementary Medicine prophesied that diseases of the respiratory system would become prevalent in the winter months that lay ahead. Many readers will now admit the accuracy of this statement since by now they will probably themselves have experienced one of the ailments that were described-and the author has been no exception to the rule! In this article, further diseases of the respiratory system will be described. Pneumonia This disease affects the lungs. There are two main varieties, lobar and broncho-pneumonia respectively but reference will also be made in this article to other types such as aspiration and hypostatic pneumonia. Before, however, proceeding to a description of these kinds, it is desirable to describe briefly the anatomy and physiology of the lungs. These two spongy organs are situated one on either side of the chest. They are shaped rather like pyramids with their bases, which are hollowed out, resting on the diaphragm and their apices extending into the neck in the' hollows above the clavicles. Their inner surfaces are also hollowed out to make room for the heart. Deep grooves, called fissures, divide the lungs into lobes. The right lung has two such fissures dividing it into the upper, middle and lower lobes; the left lung has only one fissure and hence an upper and lower lobe. The two bronchi conveying air from the nose and mouth, enter each lung on its inner surfaces at a position commonly called the root of the lung. Each bronchus then divides and sub-divides into innumerable branches like those of a tree so that all parts of the lung ha ve air distributed to them. The actual branches become smaller and smaller as they SUb-divide and are called the bronchioles as they finally open into the minute structure of the lungs.

By A. David Belilios M.B., B.S. (Lond.), D.P.H. (Eng.) This consists of innumerable air .sacs Of alveoli separated from each other by very thin walls through which the exchange of gases between the blood and the air takes place. The alveoli can be likened to the holes which are found in ·a sponge. Each lung also receives at its root a main branch of the pulmonary artery carrying impure blood; this similarly divides and sub-divides until its capillaries come illtO close relationship with the alveoli. Minute venules, also closely related to the alveoli, join up with each other forming larger and larger veins until finally the main pulmonary veins leave by the root of each lung carrying their purified blood back to the left auricle of the heart for distribution round the body. The normal movements of breathing are brought about by the action of the diaphragm assisted by the muscles between the ribs. When there is difficulty in breathing, extra muscles can be used; these, called the accessory muscles of respiration, include some of those of the neck, and chest. Lobar Pneumonia Before the discovery of sulphonamides, penicillin and more up-todate drugs of this kind, lobar pneumonia was a much dreaded disease and often called ' captain of the kings of death' since it struck down suddenly, and frequently fatally, adults in their prime of life. The disease is an acute infection caused usually by a germ called the pneumococcus. This may enter the body by inhalation and reach the lungs directly or after circulati ng in the blood stream. Its effect on the lungs is to produce 'consolidation' of one or more lobes. The word 'consolidation' means that the affected lobes of the lung have become solid; the normal light and spongy tissue alters its appearance and becomes like a piece of liver and loses for the time being its function. This is due to the alveoli having become filled with jelly-like fluid.

The illness begins suddenly with a severe attack of shivering accompanied by a marked rise in temperature often to ] 03 0 or 104 OF. The patient complains of headache, pains in his limbs, a dry irritating cough and a sharp stabbing pain in one side of the chest which is worse on deep breathing and coughing and is due to pleurisy. There is usually shortness of breath and the usual symptoms and signs of fever. The cheeks may be flushed but there is often a bluish hue (cyanosis) to the lips and ears. Sometimes a crop of spots-almost like blisters-break out round the mouth and are a variety of shi ngles. A characteristic feature is that the patient coughs up a thick, dark red or rusty phlegm. If untreated by the drugs above mentioned, the patient's condition rapidly deteriorates; the breathlessness increases and delirium may occur. Recovery, when it occurs, is dramatic and usually takes place on the 7th day of the illness when the temperature which may now be 104 ° or 105 ° falls suddenly to normal by what is called a crisis. Convalescence is rapid. Treatment with modern drugs completely alters the picture and almost as soon as the disease is diagnosed-or even before-there is a quick improvement in the patient's condition, the temperature falling rapidly with disappearance of all the unpleasant symptoms above described. Moreover, complications have now become rare when these drugs are administered. Broncho-pneumonia This occurs when inflammation affects the bronchioles and the air cells which are clustered round them. The result is a large number of small patches of consolidation scattered in several lobes of the lungs. The ailment is most frequent in childhood and old age. Jts causes are numerous. Thus it may result from the downward spread of bronchitis, from influenza, measles and

FIRST AID & NURSING, NOVEMBER DECEMBER 1956

whooping cou~h. O.ther imp~r!ant causes include drawmg-down IJ?-tO the lungs septic or foreign matefl~l, for example, from the mouth m unconscious patients such as those suffering from apoplex~, bloo~ .and vomit in various first aId condltlons and also food and drink when attempts are made to feed an unconscious patient. When a, bron~ho pneumonia results from d~a:Vlll~ down' in this way, the condl.tlOn IS called an aspiratiol7 pneumollla. The symptoms develop more gra.dually than in l~bar pneumolll.a. They include a raIsed temperat~te, quickened pulse and rate of respiration with, of course, cough accompanied by sputun: wl~ich, however, is usually yellOWIsh m colo~r but not bloodstained. The duratIOn of the ailment is often longer than that of lobar pneumonia and the temp~r ature drops gradually to normal WIth recovery by the method called a lysis. Hypostatic Pneum~nia This is common 111 the elderly who are confined to bed through some other cause, e.g. a fractured femur and who through general wea~ess do not expand their lungs .suffiCIently with respiration. . In hypostatic pneumoma the temperature may be only a little above normal. Emphysema . This is a common complalf~t particularly in the eLderly. It IS caused through the alveoli of t.he lungs having become distended wlth air to such an extent that they lose their elasticity; moreover the walls between the alveoli may break down completely thus decreasing the effective area of the lungs. Emphysema ~evel?ps gradually and is a chromc alIment.. It LS particularly liable to occur m those who suffer from recurrent ~ttacks of bronchitis owing to the stram cal~sed to the lungs by frequent cough1l1g, e.g. the regulal: ~inter cO~lgh of the chronic bronchLtls. The aIlment may also result from asthl1:a and. IS sometimes traced to playmg muslcal instruments such as the oboe. The chief symptom is shortness of breath which in bad cases oc~urs with even the slightest exert1?n. This is associated with defectl~e chest expansion and. often a chromc cough and cyanOSIS. 1.'reatmeD:t, unfortunately, is of very little avail.

years since it appears to be on the Bronchiectasis increase. This is one of the rarer diseases The di ease develops gradually. and affects the smaller bronchioles Cough, shortne of breath, bl?od which develop along their course stained sputum, and 10. ?f weIght what may be described as 'small are the main charactenstLcs' the pouches.' These tend to collect diagno is is usually ma~e by X~ray sputum which putrifie throu.gh t~e or by undertaking a specLal examm~ action of germs. Bronchlect~s~s tion called a bronchoscopy. Thl~ may be a complication. of bronchltls consists of examining the b~onchl pneumonia or other disease of the by passing a narrow, tubular 111 trulungs. One or both of the lower ment through the larynx and trachea. 10 bes are affected. This instrument, called a bronchoThe chief symptom is a cough scope, is illuminated. . which occurs particularly in the So far as the cause I concern~d, morninos when the patient changes recent research sugge t that smoking his po~ition from lyil?g down. to particularly of cigarettes plays an sitting up or fro.n~ ide to. SIde. important part. A 101:~ and te~h This change of POSition results 111 t~e nical article in the British A1edlcal sputum which ha been st~gnant j n Journal dated November 10th, 1956, the 'pouches' during th.e 111ght flO\vdiscuss~s the investigations that have ing out into the bronchI. The. res~lt been undertaken. Fi~e yea~s ago, is a severe attack of cOUghlllg 11l all doctors in the Umted .K111gdom which a copious quantity of foul were asked to give partIculars of smelling sputum is brought up. their smoking habits and m.ore t~an Other characteristics include a. bad 41 000 replied to the que tlOnnaue. odour of the breath, loss of ""elght, to March 1956, 1,854 of th~se shortness of breath, occasional fe~er doctors had passed away illcludlllg and sometimes attacks of co~glllng nearly 90 from cancer of the lung. up blood. A special feature IS that These deaths have been .analy.sed the ends of the fingers tend to become with reference to the questIOnnaIres swollen and the nails curved. and one of the conclusions reached i that there has been a marked and steady increa e in the death rate Cancer of the Lung from cancer of the lung as the This complaint has ~een very amount smoked increases. much in the news dUrIng recent

Bevol"tio"ary . 4dr·ice . OIl SecoJld"ry S/.acl... Treat".e"t advice upon T HEtherevolutionary treatment of secon~al:y shock given by Sir Heneage Ogtlvle at the Surgeons' Confe~'ence recenqy, reported on the followlllg p:'..ge, WIll, doubtless, startle many of our readers, as it did the syrgeons ~ho listened to his stimulatll1g lecture at B.M.A. House. Warmth has always been considered an integral part of the treatment of shock, whether primary or secondary, and any variation of this treatment lll~LSt be regarded as revolutionary: HIstory, however teaches us that 111 the past pioneers: whether in the field of medicine and urgery or any .other sphere, have always. met ~Ith a reception - LIster hi mself, 1lOS t ·le I H a r1 Lam Galen, Ambroise Pare, W·Il·

vey, James Simp on and Edw~rd Jenner are but a few names whIch crowd , one upon the other- before their theories have been finally accepted, often long after theLr death. Today no-o.n~ would dare to question any OpII1Lon expresse~ by so eminent a surgeon as Su Heneacre and, doubtle s, the comilers °of the new edition ~f ~he ~fficial S.lA.A. t~xt-book :V1lL g~ve seriou consideratIon to hls w.o!ds before finally reaching a decl 1011 upon the treatment of shock. In the meantime tudents and con~ petitors must bear in mind that until such a decision has been rea~hed they will continue to be eX~llune~ and judged upon the teachlllgs 0 the 40th edition.

F1RST AID & NURSING, NOVEMBER/DECEMBER 1956

S.J.A.B.

Surgeons~

Conference

By F. C. Reeve, F.Z.S., F.R.E.S., F.I.C.A.P. TH~ Ambulance and ursing Movement to. give a summary of the plans of the . IS taken ror granted, for today it forms ~[jgade for the future, he felt that he \-"ould an IOtegral part or our very existence, and IJk~ to add his own weJcome to Dr not.hIng but some terrible catastrophe, KrJtz!er~Kosch. He then spoke of th~ whlc~ would suddenly terminate the work associatIOn of t~~ Brigade with the Civil of thIs m~)Vement could possibly bring us Defence Aut~oTltJes , and we were lucky to to apprecIate (ully the part that it plays in have a man lIke General Kirkman as head our everyday lIfe. The public put implicit of e.D. Civil Defence was one of our confid~nce In those who are in possession national problems, and we were all in it. of ~ertlfi.cates signifying that they have been We do. want, however, trained first-aiders tramed 10 th.e movef!1ent, and are qualified recog,?lsed hy the authorities. to render .skl ~led assIstance to their felJowMajor ~hite Knox thanked Brigadier creatures I n tImes or emergency or distress. Daly for hiS valuable words of advice. How often, however, do we give a second T,he chaIrman then invited Sir Heneage thought to those professional ladies and OgIJ\ Ie to deliver his lecture on: gentlemen t.he. surgeons, who give so freely _of theIr time and skill i.n teaching 'MASS CASUALTIES AND SURGICAL t~ese :,tudent~ to become profiCIent in first SHOCK' ' al~ and nurslOg and other allied subjects . The lecturer commenced by remind in without which they would be unabie t~ ,Sir Heneage <?gilvie who lectured on IllS hearers that the principles of wounJ render those services to mankind? Behind Mass Casualties and Surgical Shock. ' treatment :vvere worked out forty years ago the St. John Ambulance Brigade is an army and are ?tIll a.bsolute, being modified only of over 500 surgeons who themselves are principles of prophylact ic wound excision In details dIctated by new accessory sel~om seen in public, but' upon who~ the a procedure which came to be styled i ~ methods. Few sUf!~eons,. he said, see Bngade depends for its very existence. and ~~rectl!" . but concisely. 'debridem~n~' more than one war 10 a lIfetime, and are to whom a debt of gratitude is due which e pnnclples which emerged from th~ unwilh?g to learn afresh. He emphasized could never be estimated. A few weeks first world war must remain the basis of the dIfference between civil and ago the Brigade surgeons met for their war su~gery. These he attempted to surgery . . War, be said, is both horrib~~ Annua! Confere~ce at the Headquarters of summanse. and merCIless, and the whole aim is to kiJI the Bntlsh Medical Association in Tavisas . many as possible of the other side as Basis of War Surgery ~ock Squa re, whe~e many questions affectqUlckly and ,cheaply as possible. CasuallDg th.e orga~lzatlOn were discussed, and The. p~wer of .all healthy tissue to fight ties are..a nUlsa~ce, and must be got out of four mterestmg .lectures delivered. The ~acte!,la IS effectIve except in the case of the ",:ay as qUIckly as possible. Medical Conference occupIed two days. JOv~slOn by u~usually . virul~nt organisms. supplIes and h,?spital personnel must make T.h e chair was occupied by Major A. C. ~eslstance of tIssue to mfectlOn is governed way for fightlllg units and equipment WhIte Knox, O .RE. , M.C., M.B Ch B y the state of. health, food, water and War . surp-e~y, therefore, is dictated by thes~ Su!'geon-in-Chief, the St. John A~buJa~c~ m.en~al ~nd boddy rest, and locally by the c~nsl~~ratlOns rather than chosen on Brigade, who was supported by Brigadier elJnllnatlon of unhealthy tissues by f SClentltJc grounds. Bearing in mind these T. D . P~ly , e.B.E., M .e., M.A., Deputy egres~ to the products of the inA~rnmat~~; act.s, the fundamentals of war surgery are f CommlsslOner-in-Chief, S.J.A.B., Dr. reactIOn and by rest of the injured part III SImplest t~rms, the treatment of lacerated M. M. SC'?tt, Deputy Surgeon-in-Chief The entry and multiplication of bacteria i~ and contammated wounds. Some of his S.J.A .R , Sir Heneage Ogilvie, K.B.E.: avoured. by. ill-health , starvation or ~arers m!ght question his statement that M .A., M.Ch., M.D. , F.R.C.S., ConSUlting dehydration In the individual attacked t e prmclples of treatment of infected Surgeon, Guy's Hospital, J. C. Graham a~d . I~cally by a reduced blood supply l~ wou.nds ~ere worked out in 1916 and Esq., M .R .e.S., L.R.C.P., Medical Office; t . e Injured part, by the presence of dead reml.nd hIm of the work of Lister 36' years to . Messrs. H . J. Heinz Ltd ., and Dr tlssues <?n whlc.h they cao feed and mUltiply preVIOusly. Lister'however . . ' Whl'lst pomt. th KrJtzler-~osch, Ordnung-Bundes, Artz . . ~Y t~nslOn which retains the inAammator; I~~ De "."'ay t~ the solutIOn of the problem In opeOlng the proceedings Major White I~~ a~ges and at the same time interferes o m ectJ<?n, dId not solve it. This was due Knox re.mmded the assembly of the terrible WIt t e blood supply of the inflammatory t~ ~w~ clfcums.tances, viz., the surprisin lo~s whIch the Brigade had recently suszone, and by I~cal movement. Accidental hrOitatlOns of hIS own character and t th g la~n~d by . the ~eath of its beloved Comw?unds ar~ dl'~'lsible into two stages, those fact that he liv~d in an era of peace. 0 Th~ rrusslOner-m-Chlef, Lt.-General Sir Otto o contammatlOn and those of infection woun.ds th~t LIster studied were the comLund, K.C.B., D .S.O. He doubted jf In the fir.st stage bacteria are present on th~ parat~vely Simple ones of civil life. Wounds there had ever been anyone in the Brigade surface, In the second they have multiplied contamuw l~rge amounts of devascularised ;.ho had done more for the profession than on the bloo<;i-c!ot an~ dead tissues of the and devltahsed tissue were almost . Ir .Otto, for he had always been most hos.t. The mterval IS an indefinite and knot n .. It was believed that if the surg~o~ anxl~us to advance the cause of the vanable on~, . dependent upon many c~u k~ll the germs and prevent the entry ~edlcal profession ? and he referred parfactors. .It IS 111 this interval that the o res ones, the whole problem was tlcularl.y .to th~ tn~ute. paid by the late s~rg.e~n, I. n theory, can arrest the progress ¥,~ved, the wound healing by first intention Corru;nlss.lOner-m-Chlef 10 his foreword to o I~hectlOn. Prophylactic excision or h ~ ~ow~r of resistance to infection of the .Bn~ade Surgeon.' The assembly debndement, is, therefore, the basic 'proea ~ y tIssue was forgotten in the en stood 10 silen.ce for two minutes. cedure of war surgery. Complete debrideth.usla~m .of the. crusade which followed Tn extendmg a welcome to all those mednt, . however, presents maoy difficulties LIster s dlscovenes. Surgeons of the first present, the chairman referred particularly an . ,IS seldom possible. Prophylacti~ world war firmly bel leve ' d th at mfection . to the presence of Dr. Kritzler-Kosch eXCISion should be performed layer b h a d been overcome. \\h'hom tbey were so pleased to see with The .subcutaneous layer can, ho1layer. After a brief reference to tbe stru 1 t em that day. between the new and the old . . I gg e ~I~~d be eXCIsed widely~ for fat has a poor pnnclp es he . d d . This welcome was supported by Brigadier . ~ , supply. ~nd little resistance to remlD e hIS hearers of the Carrel Dakin T. D . Daly, who saId that he had attended 10 e~tlOI?' J?,xclslOn is a hope, but conmethod, n~~er and less harmful antise tics nearly, all the c(;:>nferences since he bad held tammatIOn IS a fact. Drainage must t such as bnlllant green and flavine B I p office III the ~f1gade, and he regarded each fe fo~gott~n. Excision, drainage ~~d and lymphagogues such as hype(to~i~ ~ait ~re a <l: fam~ly gathering where tbey could ~~blhsatlOn are, therefore, the basic or mag. sulph., advocated by those who et t elr hair down.' Before proceeding pr.IOC:lples of treatment of traumatic war were at the same time working out the In.Junes.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1956 These principles had been forgotten by the second world war, but they were soon re-discovered and applied, modifications in principle being only in detail. Mechanised warfare enabled the wounded to reach a surgical centre in time for effective treatment. Two new methods appeared in the second world war. blood and blood fractions, and chemotherapy, and these had a profound influence upon the treatment of traumatic injuries. In the second world war stored blood enabled transfusion to be undertaken more widely, and within a short distance of the battle. The number of cases of infection by anaerobic clostridia was greatly reduced. Chemotherapy was valuable for, although it has limitations, it established an effective guard at the front line between dead and living, and made excision possible.

Closed Plaster Treatment Dealing with the closed plaster treatment of wounds, he regretted that it had been abandoned during .fighting in the western desert, on account of lack of skilled supervision and the impossibility of changing dressings during transport, for even a small degree of haemorrhage or oedema could convert a closed plaster into a constricting case and thus lead to gangrene. It also had the disadvantage that return to function was delayed, because wounds heal slowly by granulation, and joints are immobilised until the wounds are healed. In many circumstances, however, the closed plaster is an ideal treatment, especially where help is mostly unskilled. The lecturer went on to relate the difficulties wh ich were encountered in the desert campaigns, including the speed of movement in the forward area, lack of essentials, the long distances between forward medical units and hospital and only simple attention during transit. In the circumstances wide drainage, box splints and the late excision and suture at the base after inflammatory reaction had subsided became accepted. In Italy and France conditions were different. Surgical units were available and communications were rapid. The forward units were near the fighting and advanced base units were close behind. The forward surgery of wounds became part of a planned scheme of two-stage treatment, the second stage of delayed primary suture being carried out from three to five days later at a second unit farther back. From every point of view, said Sir Heneage, such a plan of wound treatment is ideal. Time and suffering are saved, early healing is attained and function is re tored as early and completely as the loss of tissue will allow. This, however, is not likely to be possible in atomic warfare. Atomic Warfare The lecturer then endeavoured to visualise the conditions which would obtain in atomic warfare, but warned his audience that this was only his own opinion, for no-one could do more than theorise. They had, however, learned much from the two explosions in Japan and also from later experiments. Atomic bombs would be limited, for they could not be massproduced. They would, therefore, be used for destroying military targets rather than for killing individuals. He believed that the atomic phase of any war would not

~a~t . more tha~ two days. Traumatic IOJunes, he belteved, would falJ into two categories, those incurred in the atomic phase last~g for, perhaps, two days, and post-atoauc casualties. The first pbase would include flash and deeper thermal burns, crush injuries, fractures and lacerations. In the second phase would be found wounds byordinary weapons of war, but caused by high explosive rather than by small arms. The treatment of these would be complicated by (a) dislocation of supp.'ies and communications and (b) varymg degrees of radiation sickness. Plans were being prepared for dealing with these contingencies, and he hoped that all t~ese factors w?uld be considered. ReceptIon centres WIll be prepared outside the p<?ssible danger zones, skilled personnel wdl be allocated to specific duties and partly trained volunteers have been enrolled. Burns centres are being planned in which means to combat shock, to avert infection and to provide skin cover for destroyed areas of skin have been worked out. The effects of irradiation will receive special attention, for he reminded his hearers that diffuse radiation, which is not lethal within a few days , attacks particularly the haemopoietic tissues and the alimentary epithelium, so that the entry of bacteria is facilitated and the protective reaction of the body to their entry is interfered with, whilst haemorrhage from infected areas and denuded surfaces adds to the difficulties of treatment. Sir Heneage emphasized the importance of the provision of bacteria-free air and surroundings, the prevention of infection by chemotherapy, transfusion, the replacement of Auids, particularly with solutions such as Dextran , and the replacement of protein loss by a high protein diet in planning treatment. Plans were also being made for the specific treatment of nelwlogical, thoracic, orthopaedic, faciomaxillary, ophthalmic and oto-Iaryngological casualties.

Anticipating Difficulties After enumerating the many difficulties which were visualised, the lecturer pointed out that many of these could be anticipated, and mentioned particularly the laying in of stores of commodities , not the least important of which was blood, which is a first essential, as well as other transfusion Auids. Plaster of Paris , sterile towels, dressings and suture and ligature materials will be needed in large quantities . Chemotherapeutic agents will be the ma in instruments of a surgical unit, and sulphonamides will be the chief stand-b) . A plan of sorting and a scheme of priorities should be prepared beforehand, and he proceeded to outline a most comprehensive scheme, which his audience obviously appreciated. In preparing their plan of treatment they must ever have before them the question of after-care and evacuation. If evacuation is unlikely and facilities for dressing few, then the closed plaster method is the right one. [f transport is uncertain, then some form of padded plaster splint will allow access to the dressings, and must be preferred. He impressed upon his hearers that in all circumstances chemotherapy is an essential part of wound treatment, but the only chemotherapy which can be used for mass casualties are the sulphonamides, which are simple, standardised and foolproof. They are cheap, plentiful, compact,

5 durable, easily administered in standard doses an~ highly effective against ordinary pathog~D1c ~acteria. Nothing so simple IS pOSSible With any of the antibiotics. Shocks Concerning Shock , Another important aspect of the treatment of mass casualties,' said Sir Heneage , is that of resuscitation . This is an aspect of which you of the St. John Ambulance Brig~de ar~ pa rticularly expert.' Then, in dealIng WIth the question of shock he dropped a bombshell. After remin'ding hiS audience that shock is, clinically, a state of collapse, accompanied by low blood-pressure, he said that failure of the force of the heart-beat is not a feature of the collapse that follows injury in a healthy person. Loss of circulating fluid and Jack of peripheral resistance are the main factors. There are, he said, two varieties of shock, primary or nervous shock and secondary or wound shock. The first is d~e tO,loss of peripheral resistance, that is, dllatatlOn of the arterioles due, chiefly, to emotion or pain, whilst the second is due to loss of circulating fluid, either blood or serum, and is traumatic in character. Primary shock may be accompanied or followed by secondary shock. After deal, ing with the principles of treatment, familiar not only to the surgeons present, but to all trained members of the Brigadehe came to the question of warmth, and it was here that he made his audience sit up and take notice, for he admitted that he had already caused some confusion by his writings. Warmth is beneficial, or, at ahy rate, comforting, in primary shock, but it is harmful, and even dangerous, in secondary, or wound shock. The low blood-pressure is due to loss of circulating fluid, the result of the contraction of the peripheral bloodvessels. The temperature is lowered also in the attempt to reduce the demand of the blood-starved tissues for oxygen. Warming a patient in secondary shock harms him in two ways; it dilates the skin vessels and takes the blood away from the more important tissues that are already starved, and increases the demand for oxygen on the part of tissues that are already getting too little . There is a very safe rule. If a patient feels cold and complains of cold, he is suffering from primary shock. Warm him . If a patient feels cold, but does not complain of cold he is suffering from secondary shock. Keep him cool or cool him still further. The second need in true shock is for restoration of the circulating volume. The lost fluid should be replaced quantitively and qualitively-blood with blood and plasma with plasma. Returning to the subject of transfusion he emphasized that the greater the dl.saster the more is blood needed, and m an emergency they must be prepared to use cadaver blood. Upon reflection this is not as repugn ant as might at first appear. No special apparatus. is requir~d, only sodium citrate, care being taken m crossmatching. Simplicity is Keynote Summing up , he said that. the treatment of traumatic injuries of war IS governed by basic pathological princip!es, a nd the ~ey note is simplicity. Pnmary sutU.rID.g, though safe if the surgeon could remam In charge until healing is completed, must be

6 avoided. He must use methods which are fool-proof, for the patient may be a fool, and he may pass through the hands of many fools on his journey. When the applause had died away Major White Knox said that they were most grateful to Sir Heneage for h is most inspiring lecture, and they fully appreciated the great honour which had been conferred upon them by the presence of so eminent a surgeon. Commenting upon the lecturer's statements on shock (which Sir Heneage admitted to me afterwards he had written specially for the occasion) the chairman said that he was aware that some writers had been pressing to do away with the , hot, sweet fluids.' Replying to a battery of questions, Sir Heneage said that on no account may drinks be administered if a long anaesthetic were antjcipated. If drinks were given they should not fail to include it in the information they furnished on the card. , INDUSTRIAL FIRST AID ' The next speaker was J. C. Graham, Esq., M.R.C.S ., L.R.C.P., Medical Officer to Messrs. H . J. Heinz Ltd., who spoke upon' Industrial First Aid.' • There is no such thing as industrial first aid,' said Dr. Graham, after acknowledging the honour he felt in having been invited to lecture before the Conference, • any more than there is a disease called industrial appendicitis.' He spoke with rather strong feelings because in the few years he had spent looking at industry he received the impression that quite a lot of doctors, and many more nurses, look upon first aid as unnecessary, even harmful, and certainly none of their concern. He felt, however, that this was not true of any of those present at that Conference-they were all converted! Sometimes they came up against the industrial managements, who were not always sympathetic to the movement, and he appealed to his hearers to take every opportunity of questioning their industrial patients upon the position in their particular firm. Comparing road accidents with factory accidents he emphasized that it is easier to do something about the latter whereas the former presents difficulties.

Statutory Qualification Required Dr. Graham expressed deep concern over the term ' trained in first aid' used in the 1937 Factories Act, and which applied to the person appointed to take charge of the first aid equipment, and the difference in the regulations governing the ] 0000 factories employing over 50 employees 'and the 218,000 employing less than 50 workers. The first aid conditions should be more uniform for all factories, irrespective of the number of employees. He regretted that for. mar:y large employers in the country no leglslatlOn upon this matter existed althoug.h ~e bel ieved. it is pending. ' Any lDcIdent requIrIng first aid attention f~l~s into fou~ stage~: (a) Rescue (b) RecogDltlOn or diagnOSIS (c) Resuscitation or other treatment and Cd) Remedy to prevent further occurrences. He reminded his heare~s who, ir:cidentally, were all either examm~rs or Judges, or both, that the J?hrase Any further danger?' is on the lips <?f every first aid competitor, yet in real lIfe we hear many tragic stories of the feScuer suffering the same fate as the

FIRST AID & NURSING, NOVEMBER/DECEMBER 1956 casualty. Suitable equipment should be provided to meet the appropriate potential risks. Possibly it came as a shock to many to learn that in 1954 no less than 122 persons were electrocuted in industry, yet in how many industrial concerns will be found readily available rubber boots or a rubber mat and a pair of thick rubber gloves? He reminded his hearers that gassing was another serious risk in industry. There were 237 cases in 1954. To remove a victim from a confined space- described in the Factories Act as ' any chamber, pit, pipe, flue or similar confined space in which dangerous fumes are likely to be present '-there should be provided (a) suitable breathing apparatus (b) suitable belts and ropes and (c) adequate means of egress. Referring to the special risks attached to certain industries he mentioned some food factories, in which the risks included acetylene, ammonia, benzene, carbon tetrachloride, chlorine, methyl chloride, toluene and trichloroethylene (trilene). 'Needless to say,' he hastened to add, amidst laughter, , these do not go into the food products of these factories.' All these materials were in daily use and presented problems. Diagnosis Difficulties Dr. Graham went on to refer to the difficulty of diagnosis, not only to the first aider, but often to the practitioner himself, by the continual introduction of new materials. In the larger, well-developed industries every possible precaution is taken to protect the workers, but the smaller units are often not so well served. He congratulated the compilers of the new S1. John official text-book, which will deal at some length with some of the commoner poisons to be encountered in industry, but each firs; aid worker needs training in his own panicular hazards. He emphasized, however, the importance of relating the teaching of first aid directly to the hazards to be encountered in a particular industry. The lecturer commented upon the work which had been done in America On artificial respiration , but he regretted that what had been overlooked in the States was that, wlulst the Holger-Nielsen method was now considered the best taught, the second-best choice was Sylvester's. He recalled, also, that pure oxygen was now administered in place of the obsolete mixture of oxygen and CO 2 • Perhaps no country in the world has introduced more legislation governing health, safety and welfare in industry, yet there are still 185,000 accidents a year notified to Factory Inspectorate. 700 of these are- fatal cases. Handling, Lifting and Carrying I was pleased to note Dr. Graham's criticism of the methods employed in handling, lifting and carrying, for I have, time after time, in the pages of First Aid and Nursing, drawn attention to the necessity of learning the rudiments, at least, of body mechanics. This would, said the lecturer, reduce strains and backache, and he produced most convincing figures to prove his point. Dr. Graham concluded by reminding his audience that, as a result of the high cost of labour we were rapidly learning to , do it ourselves,' and in consequence the

home was rapidly becoming an industry, but the tools and materials required are controlled by no factory acts. He mentioned the amateur electrician as an example of these increasing risks. He concluded on a note which left a strong impression on all his hearers-' We, as doctors, have a duty to prevent as well as treat accidents, and the fundamental question we must ask in every case is: Why was this man injured? How could this accident have been prevented?' After Dr. Graham had replied to a number of questions from members of the audience, the chairman thanked him most cordially for a most interesting and instructive lecture, and the assembly adjourned for tea. In the evening the guests were officially received by the Surgeon-in-Chief and Mrs. White Knox, who then led the way to the Banqueting Hall for the Annual Dinner. PRESENTATION Then came the event to which all had been looking forward-the presentation to Major White Knox of his portrait, painted by Miss Anna Zinkeisen, to commemorate his 50 years' service to the Brigade. The portrait was unveiled by Dr. Taylor-Young, and the presentation was made by Dr. M. M. Scott, the Deputy Surgeon-in-Chief, who reminded the guests that it had been contributed to by over 500 Brigade surgeons and represented the high esteem in which the Surgeon-in-Chief was held by all. In his reply Major White Knox said that he was deeply touched, and recalled with pleasure the many years he had spent in the service of the Brigade. He also thanked the artist, Miss Zinkeisen, who had been so delightful to him dudng the sittings. He was almost sorry the sittings were over. The presentation to Mrs. White Knox of a beautiful bouquet, and the singing of ' For He's a Jolly Good Fellow' proved a fitting climax to the first day of the Conference. PROGRESS REPORT The second day opened with the Surgeonin-Chief's Progress Report and talk on medical matters generally, including the 41st edition of the official text-book , First Aid to the Injured.' He commenced by extending a special welcome to the surgeons from Ireland , and referred in glowing terms to the close relationship which existed, despite political differences, between north and south. Continuing he informed his hearers, amid applause, that they had had ] 54 surgeons join them last year which, taking into account redundances, resulted in a net increase in numbers of 115. A tribute to his Staff Officer, Mr. George Craft, terminated a most encouraging Report, the details of which would be far too numerous to include in this article. The discussion which followed the Report brought out some very interesting suggestions for the new edition of the official text-book, all of which will receive very careful consideration. 'SECOND AID ' After coffee the chairman invited Patrick W. Clarkson, Esq., M.B.E., M.B., B.S., F.R.C.S., Casualty Surgeon, Guy's Hospital, tQ deliver his lecture on ' Second Aid .' Dr. Clarkson disclosed that last

FIRST AID & NURSING, NOVEMBER/DECEMBER 1956 year there were 111 million attendances at the Casualty Department of Guy's Hospital, and a large percen~age of these were hand wounds. The stram on the Casualty Department of any general hospital was becoming increasingly severe, and suggestions were constantly being made for some improvement in the sys.tem. Some .advocated that certain hospitals be nommated to deal with major accidents, othe~s that a chain of special accident hospitals be established throughout the country. The details furnished by Dr. Clarkson certamly provided food for thought, and he was most enthusiastically thanked by the chairman on behalf of all present. Stores Dept. Older than Association He was followed by H. J. Wrigglesworth, Esq., M.RE., Stores Manager, . qrder of st. John, who opened by adrruttmg that figures are often boring, but he felt that those he had before him would prove of exceptional interest. It came as a surprise to many to learn that the Stores Department was even .older th~n the Association , but he explal,ned that It commenced by the importatIOn of stretchers from France and Germany. They then turned to manufacturing, not only stretchers but horse ambulances, and he referred to 't he valuable work of the late Sir John Furley, and this. eventuall.y led them. to undertake exportmg. Thel~ first, p~lbllca tion was a text-book entltled Aids to First Treatment,' and was the fo~erunner of the present' First Aid to the IDjured:' . In 1914 the Stores Department was eqmppmg hospitals throughout the cour:try. Before the introduction of the NatIOnal Health Acts the Brigade owned] ,000 ambulances. Tracing the development of the A.R.P. movement he recalled the important rO.le played by their Stores Departme.n t. Jll supplying requirements, even deslgDl.n~ their badge for them. 'And, .a11 thiS, concluded Mr. Wrigglesworth , IS carned out by a staff of only 14.' . . 'A most interesting and enllghtenlDg report,' commented the chair!Uan , and he extended to the speaker the sll1cere thanks of the audience. Plaster Slabs Returning after lunch we found t~at the lecture room had been converted mto a demonstration hall , where we we:e welcomed by General Drummond, Dlrect,?rGeneral of Civil Defence, together With Col. Waterson, in charge of the R.A.M.C. at Mill Hill. With them were a team of R.A.M.C. personnel and a number of nurses of the Q.A.R.A.N.C., who were to demonstrate the value of plaster slabs. 'It was now' realised,' said Gene~al Drummond, 'that these could be used WIth advantage in first aid work, and we propose to show you how simple the pro~ess can be~ and how it can be adapted for thiS purpose. Col. Waterson explained that .the slabs couLd not be moulded over cloth! ng, but a silk stocking need not be removed. He explained that no attempt is ma~e to reduce the fracture or dislocation, but It ~l~d been found most effective in i.mmobdlsl~g the limb during transit, and cOt;Jld easIly be removed upon arrivaL at hospItal, although in cases of necessity it could be left on for as long as 3 or 4 days. We then saw several fractures and dislocations treated. including Colles', Potts', h1.1merus, patella,

elbow, shoulder and ankle, all of which we were invited to examine at close quarters. General Drummond, Col. Waterson and their assistants were thanked most cordially by Major White Knox, at whose request

the demonstrations had been arranged. An open discussion and summing-up by the Deputy Surgeon-in-Chief brought to a close another most interesting Surgeons' Conference.

tJasnalties Union Ne,vs ANNUAL CONFERENCE THE climax of a successful year's work of Casualties Union activities was reached when at the week-end of October 5thf7 th, the Annual Conference and Casualties Union Day was held. A large number of delegates from Branches and SIC from all parts of the U.K. attended the two-day Confer~nce which was held at the Metropolitan Regional Hospital Board H.Q . in Portland Place, W.1. Some good speeches on a variecy ~f C.U. subjects were heard, and demonstratIOns of make-up, and acting without m.ake-up were staged by London and Altnncham Branches. An excellent colour film of first aid and rescue was shown, one of the best of its kind c.u. members have had the pleasure of seeing. It was filmed and acted by the Royal Canadian Air Force and the Civil Defence of . Cana?a, who worked in close co-operatIOn WIth each other to produce this splendid film. Th~ Annual General Meeting f?lIowed the closing of the Conference whIch has now been altered to fit in with the c.u. weekend thus allowing a greater number of members to attend than has bee~ the case in previous years. The expenment proved a great success. BRANCH NEWS . Sunday, October 7th, was the all Important finals of . the Buxton Trophy Competition , in which 24 teams took p~rt. The Trophy was won by the East Rldmg Constabulary, who won it in 1954. T~e competition was held at the MO~lle Defence Corps Depot, Epsom (by kmd permission of the C.O.). A record number of visitors attended, including a large number of first aiders from all groups. Stands were staffed by RoSPA, C.D., N.H.S.R., who also staged s<?me ex~ellent displays, ranging from 'AccIdents m the Home' to rescue by C.D. an~ trea!ment ?f the casualties by the MobIle First Aid Column of the N .H.S.R. Several novelties for the spectators were introduced this year for the benefit of ~e spectators, who were invite~ to try theIr hand at blindfold bandagIng, stretcher carrying and diagnosis. All of these proved 'most popular, and the. general opinion was that it all added c~I!slderably to the attraction of the cOn:p~tI!10-,? The demonstration of speclallnJunes, was once more staged by Altrincham . Branch, who put on their usual excell~nt dIsplay of injuries and diseases. ThiS year the accent was on skin diseases, and they ;howed examples of shingles and fungus of the skin. JUNIOR STUDY CIRCLE Brighton Branch under the leadership of H. C. Excell, were responsibl~ fQr Study

Circle Corner, and put on several displays to interest newcomers to C.U. technique. Mr. ExceJl has also organised a very successful Junior Study Circle at Brighton. They were trained jointly with C.u. textbooks and a Cadet First Aid Manual. Twelve of these juniors passed their probationary test and are now fully fledged members of the Union. ~r. Excell has certainly started somethlllg, which can easily be copied by Branches and Study Circles, in other parts of the country, as there is now a definite demand for junior ' casualties'. Branches continue to flourish and to do sterling work, some of them having passed the century mark for activities during the year. Perth Study Circle is now upgraded, and becomes Perth Branch, and have made a good start by enrolling eight new members. We wish them and the new Branch all success for the future. Perth Branch was also the host for a Scottish Branch and Study Circle meeting which is the second to be held in Scotland, with a view to forming a Scottish Region of Casualties Union. Yet another overseas Cu:c1e ha~ bee!1 formed, this time in Bruges 10 Belgmm, It is very encouraging to ~.Q .. to kno~ that the technique of C.U. IS bemg carned to other countries and to more and more members of the first aid groups.

Confessions of a Competition Casualty J did not know how comforting i( can be to have yo III' face wiped with a. mOist. cloth, and how refreshing to hal'e the lips mOistened when drink is forbidden. How comforting a blanket is underneath one, when/ying on the cold grollnd. How disturbing is a bright light when ?ne is lying all a stretcher and unable 10 sll1eld one's eves. HoW' easy it is to flick dust and grit on to a casualty's face with a blanket. How disturbing is the vibration of floorboards caused by a first aider's boots,. to an unsupported head of a sick person, lytng all the floor.

llIustrations of Bandaging and First Aid . The fifth edition of the above magnificently illustrated , easy to f~ll~w book has been published by E. & S. LlVln~stone Ltd , Teviot Place, Edinburgh at a pnce of 12 6. Compiled by Lois Oalces, S.R.N., D.N.

FIRST AID &

URSI G, NOVEMBER DECEMBER 1956 FIRST AID &

Gral,d Priors Trop/lies THE brooks join to form the stream, the streams join to form tbe tri?utary, ~he tributaries join to form the flver whIch rushes on to the mighty estuary. So do the local, tbe regional and the final ~om petitions lead eventl:lal~y to th.e mlgJ:ty climax the Grand Pnor s TrophIes, which were fought for again this year at the Porchester Halls, Bayswater. Twenty-one teams came from all over the United Kingdom 13 men's teams and 8 women's teams an'd the enthusiasm shown equalled that ~f any year in the past. It was. the seventh competition for men and the SIXth for women. All the tests presented interesting features, and a synopsis of them will repay study:Men's Team Test, set and judged by H. S. Taylor-Young, Esq., F.R.CS., of Salisbury: The team are walking in the country and find a brewer's van outside an inn. The driver is on the ground with a crate of beer across his legs. Injuries: Wound on left forearm, with severe haemorrhage, simple fracture of right tibia, fracture of left lower ribs with suspected internal haemorrhage. Women's Team Test, set and judged by G. M. Shaw Smith, Esq., M.B., Ch.B., of London: The team is called to a bouse where they find a woman lying on tbe floor unconscious. Part of the ceiling has fallen on her, and there is a possibility of more falling. Injuries: Concussion, lacerated wound on the head, simple fracture of right tibia, cut on left arm with glass embedded, simple fracture of left ribs. Men's Dual Tests, set and judged by Allan Walker, Esq., M.B., Ch.B., of Wolverhampton. In both tests the scene is set in a first aid post: Nos. 1 and 3 have to treat a man who has been brought to the post, having slipped and fallen on some steps. Injuries: Simple fracture of right patella, nerve shock. Nos. 2 and 4 have to treat a man who has walked into the post with blood dripping from his right hand. He has cut it with a knife. Injuries: Wound of right hand with severe haemorrhage, faints after two minutes. Women's Dual Tests, set and judged by R. H. Kipping, Esq., M.B., Ch.B., of Beaconsfield: Nos. 1 and 3 find a man lying on his right side, outside a bouse. Injuries: Compression, wound on right forehead with underlying fracture, fracture of right forearm. Nos. 2 and 4, upon entering a room, find a man sitting on a chair holding his left elbow. Apparently he had slipped on the floor and had been sat on the chair. Injuries: Simple fracture of left clavicle, shock. The tests ended, the scenery was removed and the platform prepared for the presentation ceremony, which was presided over by Horace F. Parshall, Esq., T.D., M.A. (Oxon.), Director-General, The St. John

trained patients and make-up artists, the time-keepers and all the others who gave so freely of their time, were all deserving of their bighest gratitude. In the judges they were most fortunate. These busy professional men-and often, women-were always so willing to do all they could to advance this splendid movement, and he knew that he was speaking for his audience when he extended to them his heartfelt thanks. Their comments on the work they had judged were always valued most higbly. and he asked Dr. Taylor-Young if he would be good enough to comment upon the men's team test which he had been judging.

Ambulance Associatior., before a crowded audience, and it was obvious that many had travelled from all quarters of the British Isles to support the teams in which they were interested, and in some cases the team which had beaten them at the Regionals. We believe that every British dialect was to have been heard that afternoon. The chairman was supported by General Sir Sidney Kirkman, G.CB., K.B.E., M .C, Director-General, Civil Defence; Lt.-General Sir Henry Pownall , K.C.B., K.B.E., D.S.O., M.C, Chancellor of the Order of Sf. John; Lt.-Col. E. C Croft, Deputy Director-General, The St. H[GHEST STANDARD IN COUNTRY John Ambulance Association; Brigadier T. D . Daly, D .S. O., CB.E., M.C, M.A., Dr. Taylor-Young, who stated that he was speaking for Dr. Walker as well, said Deputy Commissioner-in-Chief, The St. John Ambulance Brigade ; Major A. C that they felt that the standard they had White Knox, O.B.E., M.C, M.B., Ch.B., seen that day was the highest in the country, and because of this high standard Principal Medical Officer, The St. John Ambulance Association; Lt.-Col. J. E. F. the judges must be strict in their marking. Gueritz, M.A. (Oxon.), Secretary, The St. Dr. Walker bad felt that many of the comJohn Ambulance Association; Dr. M . M. petitors had been petrified by the clock, a Scott, Deputy Sergeon-in-Chief, The St fact which had probably been responsible for some hurried and rough work. They John Ambulance Brigade and the judges. must not f0fget that a patient could be Mr. Parshall said that it was again his hurt more by rough handling than by the pleasure to preside at this great annual original injury. Some teams lost marks event, and especially to be able to welcome because they did not wait to iisten to what Sir Sidney Kirkman, who has so kindly had happened. They had seen more than consented to present the trophies, and he one hot water bottle placed on tbe patient's felt sure that they would not be disappointed tummy. He emphasized the importance if they looked forward to a few words of of washing hands before handling wounds wisdom from him. The growing interest or dressings. Everything had been prothroughout the country in first aid is vided for this. demonstrated by the fact that the St. John Transport, he said, had always presented Ambulance Association has trained to a a problem, and sometimes competitors did high standard nearly a million students, experience difficulty in improvising some and they must try to learn how NOT to means of carrying the patient a distance. keep their light under a bushel. He hoped In tbis case, however, there was a lorry to that Sir Sidney would be able to emphasize hand, and the inn-keeper, had he been at least on;; way in which we could usefully asked, would have been prepared to drive it. employ our skill, but there was, he said, He concluded by expressing the pleasure no better way of maintaining, and even that he and Dr. Walker had experienced in improving, that skill than by competitions. judging the competitions that day. In thanking all those who had contributed to the success of the event that day he would like to mention especially the ROUGH HANDLING Associated British Picture Corporation Dr. Shaw Smith , who spoke also for Dr. Ltd., who had not only supplied and Kipping, said that they had both been very erected the scenery, but had removed it so pleased with the standard of efficiency they expeditiously afterwards in time for that had seen that day, although there were ceremony. The stewards, the St. Johnsome criticisms to be made. The teams

The winning teams being presented with their prizes at the Grand Prior's Trophies Competitions at the Porchester Halls in London.

URSI G,

OVEMBER/DECEMBER 1956 9

had done well on the whole, but two teams had missed the clavicle. He agreed with Dr. Taylor-Young that there had been some rather rough handling. Padding had been sketchy, despite the fact that plenty had been provided. The top teams had done very well indeed. He urged them all to try to do better next year. At this point Col. Croft announced the results: MEN 1. Police (L. Division, Metropoli-

tan) captained by P. C Fred Argyle ... ..... 337 (winning the Men's Championship Trophy) 2. British Electricity Ambulance Centre (Fulham) ... 302 3. British Transport Commission (Railways and Docks, Bristol) 301 4. Miners' ational First Aid Competition (Shotten Colliery) 293 5. Fire Brigades (City and Council of Bristol) 291 6. The St. John Ambulance Brigade (Camden B.R.) 287 7. British Transport com-t mission Police (Liverpool Street 'A') tied ?83 1 7. General Post Office AmbU-j - 2 lance Centre ( orth Area T.M.O.) ... . .. 9. Gas Industry ( orth Thames Gas Board) 278§ 10. National Dock Labour Board Ambulance Centre, Yarmouth) 266 11. Ministry of Supply AmbU-[ lance Centre (R.R.E., D~fford) ... ... tied 254 11. NatIOnal Road Passenger J. Transport Ambulance Association (Chiswick) 13. United Kingdom Atomic Energy Authority (Windscale Work) 248 WOMEN 1. The St. John Ambulance Brigade (Spalding .D.) '" 333 (winning the Women's Championship Trophy) 2. British Transport Commission (Railways and Docks, Baker Street) ... 306 3. General Post Office Ambulance Centre (North Area T.M.O.) 297 4. Gas Industry ( orth Western Gas Board) 278 5. National Road Passenger Transport Ambulance Centre, Reigate) .. 274 6. Ministry of Supply Ambulance Centre (S.D., Elstow) ... 269 7. British Electricity Ambulance Centre (Swindon) 263 8. United Kingdom Atomic Energy Authority (Aldermaston) 198 The chairman then invited Sir Sidney Kirkman to present the trophies, but before doing so Sir Sidney said that he wished to express the honour he felt in having been asked to present the trophie at this important competition. It was an important competition for two reasons; first, because it was the culmination of a year's hard work and intensive training and, second, because of its value in promoting th~ cause of first aid, which in itself, was a most important subject. Anyone killed

THE Casualties Union becomes more ambitious every year, but at last it has overcome its modesty, which has hitherto prompted it to call its annual event merely a ·compe6tion.' Tt will henceforth be known as 'Casualties Union Day ,' for today the competitions are almost incidental against the large number of demonstrations and other features which go to make up th is gigantic display. The importance with which it is regarded may be gathered from the various sites which have been so readily offered for it during the past few years. They include Ponders End Gas Works, Pinewood Studios, R.A.F.. Hendon, Holford Square Flats, King's Cross railway station, Hay's Wharf, the Duke of York's Headquarters and others, and we learn that next year the event will be held at the London University Sports Ground at Motspur Park. This year it was held at the Mobile Defence Corps Depot, Epsom, by kind permission of the Commanding Officer, and proved a great success. There were so many things to see that, in order to avoid the possibility of missing any of them, perhaps \ve cannot do better tban take our readers in imagination round the grounds. visiting each of the stands in turn. Entering a large garage T found Dr. Jarvis and Mr. Excell, both of Brighton. examining a candidate in acting. The candidate had been attending a Study Circle with a \. ie\\

to membership of the Casualties Union as SOon as he had become proficient. We are wondering if he passed his examination In this enclosure. also, were beino oi\'e~ demo!lstrations of . making-up' p~ltfents, and Instructors were present to answer questions and sol\'e any problems brought to them by members and others. A feature of thi - well-equipped and arranged training ground of the M.D.C is a series of special ·cra\.\ I ' under debris, and members and probationers were able to experience being introduced into \\ reckage for rescue practice~ under the super\ ision of instructors of the M.D .C. Overalls are prO\. ided to protect their clothing. The Royal Society for the Pre\'ention of Accidents had a di~play stand \\ here all phases of its \\ork (home, road, ctiild and industrial safety) were featured. Here \\e met 1iss Barbara Tai h, of the Home Safety Department, "ho was kept bus) answering the numerous Cjuestions put to her b)- interested \ isitoL This Society is doing \ aluable work by educating the public to an appreciation of the potenrial dangers to which we are all exposed during e\ery minute of our li\es. For in tructional and practical purposes home 3ccid~nts, for instance, are grouped irlto four categories. viz.. falls, burns and scalds poisoning and suffocation. At intervals during the day demonstrations \\ere staged showing the use of trained casualties in teaching accident prevention. From here we passed to the 'ational Hospital Sen ice Reserve stand, staffed by members of the Berkshire Branch of the Co. who were fully employed in dealing With the numerous questions which were being put to them. It is to be hoped that the) \\ere succe"sful

in first aid, ,\hich would enable them to succour or save a life should feel proud. Although most of them, he said, were training in peace time, yet in another world war-which they all hoped would never come-with modern weapons, what was going to happen? The outbreak may come in one night, and within a very short COIl;il/ued Ol'erlea( time casualties would be coming in. It was they, the first aiders, to whom the Obituary country would look to deal with such emergencies. There would never be BRIGADIER T. DENIS DALY enough doctors and trained nurses to cope For the second time in three months with tbe situation, and this gap would be death has robbed the St. John Ambulance filled by those he had seen that day, first Brigade of a leading figure. The Acting aiders and auxiliary nurses, whose assisCommissioner-in-Chief. Brigadier T. Denis tance would be invaluable. This, howDaly, collapsed and died at il, meeting of ever, was not enough. They must enChapter-General at St. John s Gate on deavour to make the public realise the ovember, 21st. importance of every man and woman Brigadier Daly had been ill for a conhaving a knowledge of first aid and home siderable time, but despite his doctor's nursing. The population was about 50 instructions to take things easily, he millions, yet only one million held cercourageously insisted on carrying out all tificates for first aid or hone nursing. the duties inherent in the position of Acting This was not good enough, and they must Commissioner-in-Chief at a particularl) go aU out to get this figure doubled. e'(acting time, when the Brigade's sen'ices He was delighted to have this opporwere in exceptional demand. tunity of putting to them this terrible After a distinguished military and diploproblem, and they should aim at getting at matic career, which included en'ice as least 12 million women trained in first aid military attach e in Berlin and. Paris. and home nur ing. He congratulated the Brigadier Daly had brought to hI work winning teams upon their success, and then with Sf. John qualities of personal courage. proceeded to present the trophies. . integrity and sympathetic. under tanding In thanking Sir Sidney for hIS most which were greatly appreCIated by ~Il. who encouraging address Mr. Parshall said that Hi responsIbilItIes as worked with him. they were charged with a great responDeputy Commissioner-in-~hief und~r. the sibility, and they were only just .beginn!ng late Lt. Gen. Sir Otto Lund Included IIaI ' on to scratch the urface. He paId a hIgh with government department, c}vil de~el!ce tribute to the work of the county directors, and aviation authorities. and JO addItIon and concluded by saying, . We want at he served the Order by helping to re-estableast one first-aider in every home.' lish and maintain it contact with the The arrangements were again in t.he German Order. Fittingly, he had just hands of Mr. George Craft, the ASSOCiabeen promoted to be 11 Knight of the Order tion's mo t capable Competition Secretary. of St. John.

FIRST AID & NURSING , NOVEMBER/DECEMBER 1956

FIRST AID & NURSING, NOVEMBER/DECEMBER 1956

10 in enrolling new members, for these are urgently needed . Turning a corner we nearly collided with four men carrying a stretcher, although it must have been evident to any experienced first-aider that they were novices. Yes, they were lay members of the public who had accepted an invitation to try their skill at transport, and their mistakes were being corrected by Mr. F. T. Yearson, of Wallington , who then showed them the correct technique. Later on competitions in stretcher-bearing were held for novices. It was now time for the first aid competitions to commence, so we made our way to where four sets, identical in composition and appearance, had been arranged. These included four ' bombed houses' which had been specially erected, and are permanent features of the practice ground of the Epsom M .D.C. Each team arrived in an ambulance, and was called in turn to deal with an incident, and the test consisted in, not only rendering first aid, after diagnosis, to the victims. but extricating them from the debris first. In each 'bombed house' were three victims, suffering, respectively, from (a) compound fracture of the leg and fractured ribs (b) apoplexy and (c) sprained ankle. The judges were Drs. R. S. Barr-Brown, F. H. Taylor, D . Pride, R . St. John Buxton, B. A. Pitt, Whiteside and Offard, Messrs. C. F. Blake, G. Bugden , S. W. Harden, E. K. L. Dunn, J. W. Limb, H. Marriott, Thompson and McNamara . In another enclosure the diagnosis competition was in progress, so we made this our next port of call. This was indeed interesting. Two members of each team, who were not taking part in the first aid test, had to handle and diagnose the condition of each of six patients, and this was judged by Drs. Lancelot Wills, J. S. Binning, Messrs. Waller, Matherson, West and the Misses Austin, Brand and Lock. Upon leaving this enclosure we were ~ccosted.by a lady who asked, ' Would you lIke to dlagnose a case?' This turned out to be another 'st unt' for lay members of the public, although trained personnel were not excluded. Lying in all sorts of characteristic positions patients had been prepared to represent various morbid conditions which the first aider is taught to deal with, and visitors were invited to identify the signs and symptoms. Needless to say, some of the verdicts by laymen caused considerable amusement. :rhe feeding of so l~rge a gathering mlght appear to be a senous problem, but the Women's Voluntary Service in whose capable hands this. had been plac~d, did not appear to experIence any great strain, mamly, perhaps, on account of its exceUent organization. We were pleased to meet, once again, Miss E. F. Dunn, the Convoy Organizer of the W.V.S., and Mr. Ivory, Convoy Officer from the Ministry of Food, and our inspection of the arrangements confirmed the perfection of the organization. Miss Dunn recalled with pride the recent review by Her Majesty the Queen Mother of the W.V.S. She infor~ed us that they have ten such convoys whlch ~ravel all over the country. Dunng our tour of the display we met some of the officers of the Mobile Defence Corps, which was acting as host to the Casualties Uni\ln that day, and from them we learned qUlte a lot about this useful

and important body which is prepared for a ny emergency, and may be regarded as the spearhead of the Armed Forces' contribution to Civil Defence. It will consist of 36 mobile battalions trained in rescue and ambulance duties, and capable of rapid deployment in support of local defence forces wherever the need is greatest. They gave demonstrations during the day. Another novel competition for visitors, laymen or trained personnel, was' blindfold bandaging' which, besides causing a great deal of amusement, revealed the skill with which this operation can be executed by many of the competitors in the dark. The information bureau, where any questions relating to the Casualties Union and its work could be obtained was in charge of Mrs. A. S. Lilley, the Press Officer, and her capable staff. She explained that the C.u. exists to help the first aid organizations by training and supplying skilled patients and make-up artists, by means of which students will more readily recognise the morbid conditions they are taught to treat. Candidates must, themselves, be skilled firstaiders before they can be accepted as trainees. Another stand furnished information relating to the Institute of Civil Defence, which is an independent technical association of men and women for the study of Civil Defence problems and the development of operational methods and training in peace and war. The Casualties Union Journal, which is published quarterly under the editorship of Mrs. Helen Nicholson, keeps the members all over the world in touch with the activities of the Union, and should prove of great interest, not only to the members, but to all tnose interested in the welfare of their fellow creatures. It is a good shillingsworth. A realistic display was given by the Civil Defence Corps. Rescue parties were to be seen extricating victims from positions under debris, heavy pipes and machinery which would appear almost inaccessible. These rescues, however, are made possible only after long and intensive study and training. After tea the spectators gathered before a long table, upon which were displayed the trophies, and which was prepared for the presentation ceremony, and this was presided over by the President, BrigadierGeneral Glyn Hughes, C.B.E., D.S.O., M.C., Q.H.P., who read an apology from Major-General L. A . Hawes, C.B.E., D.S.O., M.C., Controller, Home Department, British Red Cross Society, whose absence through illness was deeply regretted. Before the results were announced Dr. Wills presented a procession of 'casualties' which he accompanied by a running descriptive commentary. From these the spectators were able to obtain a glimpse of the useful work the Unionisdoing in training patients and make-up artists. The 'casualties' exhibited and described by Dr. Wills were: 1. Lacerated cut on left cheek, accompanied by shock. 2. Patient had been hit by a beam. Fracture of tibia and bruising of other leg. He had been subject to rough handling.

Crushed right leg. Wound associated with a cut. 4. Classical signs of internal haemorrhage. The cause had been an unusual one-a shower of glass through the air. 5. Shock. Patient found wandering. Memory gone. 6. Insulin shock. Patient ~Iipped off chair. Shock developed mto coma. 7. Simple faint. 'Where am I?' 8. Blow over pelvis, resulting in fracture. 9. Legs trapped in rubble. Fracture of neck of right femur. 10. Broken nose. Concussion. 11. Fall in Are. Face and arms burnt. Also grazed knee. 12. Depressed fracture of skull. Compression . Attention drawn to limp limbs. Dr. Wills commented that not one of the competitors had asked the condition of the pupils. 13. Fell out of a window on to feet. Fractured base of skull. 14. Splinter of glass in upper eyelid. 15. Grit in both eyes. Patient panicked, believing that he was going blind in both eyes. The acting of the 'patients' was most commendable, portraying the general condition as well as exhibiting the injuries. The lessons to be learned from the tests were fully explained by the commentator. It was a most valuable and enlightening exhibition. Some of them were truly gruesome, and parents had been warned that the exhibition was not suitable for the eyes of young children. Dr. Wills thanked the members who had taken part for their wholehearted co-operation. After the team test (an outline of which has already beel1 given above) had been explained to the audience, Dr. Barr-Brown proceeded to give his impression of the work and reactions of the teams in dealing with it. He emphasized the peculiar difficulties to be encountered in an incident like this, and compared it with the accident one might meet in the street or factory . In this case the apoplexy case should have been sent to hospital as soon as possible instead of 'playing about' with other details. One team did ask the age of the patient, important when trying to diagnose this particular condition . In the case of the female patient who was trapped , he bad expected the competitors to free her leg as early as possible, when tbey would have discovered a compound fracture of the tibia. In using the other leg as a splint, most of them had moved the injured leg towards the uninjured instead of vice versa -an unforgivable sin. The fractured ribs should not have presented a great difficulty, but some teams were rather slow. When tying the knot some omitted to instruct the patient to breathe out. The female patient who came from the back of the , bombed house' had been placed there as a 'red herring.' Actually, she was not a casualty at all, although she eventually became one. She had been acting as a patient for a team which had been practicing when the house collapsed. She was then uninjured, but in climbing over the rubble in an attempt to offer assistance, she had sprained her ankle. He hoped that the competitors would not be disappointed in the marking sheets. The judges wanted Continued on pace 12 3.

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Casualties Union Day-Colltinued to be fair, and they had done their best, but they could not possibly give marks which were undeserved. He said that he and the other judges for whom he spoke had thoroughly enjoyed their experience. The chairman then asked Mr. E. C. Claxton, M.B.E. , the Chairman of Committee, to read the results, which were as follows: Winner of the First Aid Trophy, for the highest marks in the first aid test: Staffordshire County Police (last year's winners of the Buxton and First Aid trophies). Winner of the Diagnosis Trophy, for the highest marks in diagnosis: East Riding Constabulary. Winner of the Buxton Trophy, for the highest aggregate of points in First Aid and Diagnosis: East Riding Constabulary. Winner of the Institute of Civil Defence Trophy, for the team of predominently opposite sex to the team gaining the highest aggregate marks: The St. John Ambulance Brigade Nursing Cadets, 25 Southgate 'A' team. Before the presentation, General Glyn Hughes extended a warm welcome to all the teams who had competed that day, and especially to the team from Dublin (cheers). They were also very pleased to have with them two officers from the United States Army, General Hayes and General Gorby. Mr. Peter Rawlings M .P ., the Member for Epsom, was another welcome visitor, for his interest would be appreeiated by the fact that he was the Commandant of tbe M0bile Defence Corps whose guests they were on that occasion. The guests of honour, however, would need no introduction from him, for they were both too well-known . He would ask Miss Pat Hornsby-Smith, Parliamentary Secretary to the Ministry of Health, and Miss Durning Lawrence to present the trophies. An amusing incident marked tbe presentation when the Buxton Trophy was presented to the wrong team! This, however, was soon remedied, to the laughter of all present. Miss Hornsby-Smith said that she wished to thank all the teams which had competed that day, backed by the Casualties Union, the St. John Ambulance Brigade, the British Red Cross Society, the Institute of Civil Defence, the Mobile Defence Corps, and all those who had contributed to tbe success of the event. She had one complaint to make- some of the sights she had witnessed had been most ghastly! She stated that the Ministry would also wish to thank them, through her, for the great contribution they were making to the work of the Ministry. They wanted far more members in their ranks . Training in first aid, she said, is never wasted. It was a good insurance to join the Casualties Union . She supported the chairman in his welcome to the two United States officers who had shown so much interest. They were always pleased to see their friends from the States. She hoped that they in their country would have a Casualties Union. She then went on to express their gratitude to the Commanding Officer of the M.D. Corps who had so kindly invited them to stage the display on tbis marvelJous training ground. The Women's Voluntary Service- well, she had two words for them: ' Bless 'em.'

FIRST AID & NURSING, NOVEMBER/DECEMBER 1956 'Our police are wonderful,' she said. they've swiped up nearly all the trophies today.' As for the chairman, well, he never misses an opportunity in his many speeches of sliding in something about the She thanked the Casualties Union. patients, many of them middle-aged and older, who are all doing a good job, a nd concluded by expressing the hope that they would all go away and talk about what they had seen that day. Mr. Claxton said that he wished to add his thanks to all who had contributed to the success of the day, and expecially to M iss Hornsby-Smith for her presence there, and also to Miss Lawrence. He referred to the great friendliness which existed between the M.D.C. and the C.U., and informed his hearers that the members of

the M.D.C. bad been at work at dawn that morning making preparations for their arrival. The judges he could not thank sufficiently, for withom them the event would not have been possible. The scorers, timekeepers, stewards and others he would like to thank could not be mentioned individually, but he trusted that they would all accept his gratitude. He wondered if his hearers realised that 117 teams had taken part in preliminary tests, and that those they had seen that day were the survivors. The presentation of two beautiful bouquets to Miss Hornsby-Smith and Miss Lawrence brought to a close a most interesting and successful day. Other competitions will be reported in the next issue.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1956 13

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• the audience From a seat In Grand Prior Do.n't send for ambulance if sitting case car would do. It's cheaper. Few palpated the patella correctly. Fancy asking ' Have you any first aid material? ' in a F.A. post. Those signals from the time-keepers' desks again! Several failed to state where the accident had taken place. The operator had to ask. Don't suggest to the patient the replies you are expecting. 'What is the pulse rate? ' Why not find out? Don't keep repeating 'Do you feel better? ' It becomes irritating. Wasn't hcr wrist-watch going? There is a correct technique for getting a stretcher through a narrow doorway. The patien.t was too helpful in removing jacket.

Make certain that you have all the material you require before commencing. 'There's no irregularity.' How did he know? There's far too much guesswork. Where should the hot-water bottles be placed? Consult your text-books. 'Is h is evidence rei iable?' This is for you to decide, not the judge. . They raised the limb (fractured patella) as an afterthought. What is ' hot, strong, warm, weak tea? ' How could she examine the spine with the patient supine? • I'll see if the ambulance is coming,' and she forthwith looked in the cupboard! Was it necessary to tell the patient to take , short , shallow breaths'? 'May I use your tie?' Why not use your own ? What happens when the doctor arrives on the scene, only to find that the patient has been transported to hospital?

Blood Grouping By W. James Wright, S.R.N., B~T.A. ALL first-aiders, at some time or other, must have heard of blood grouping. It is a very interesting subject and is quite common these days when so many patients receive blood transfusions. Grouping This is a means of finding into which group the individual's blood comes. The receiver's blood must mix with the donor's blood and in order to determine this it is given a special test. Two or tnree drops of serum taken from the patient's blood are placed on a glass slide together with two or three drops of the donor's blood, which has been diluted with a solution of citrate. The serum and blood are then mixed and examined under a microscope. If the blood cells clump together the blood is of the wrong group and must not under any circumstances be given to that patient otherwise the result may be fatal. Blood Groups There are four blood groups which were once classified by the Moss method as I, II, III and IV, but by the newer method, the International or Landsteiner method, they are known as AB, A, Band O. In the blood of most people are bodies known as agglutinogen which cause

clotting of the blood. These agglutinogens are of two kinds known as A and B. The first group contains both these agglutinogens and is therefore known as group AB. The second group contains only the A agglutinogens and is known as group A, while the third group contains only the B agglutinogens and is known as group B. The fourth group contains no agglutinogens and is known as group O . Receivers and Donors The question now arises as to which groups can give to which groups, and which groups can receive from which groups. Group AB is a universal receiver, that is it can receive from any of the four groups. 1t can only give to group AB. Approximately 5 per cent. of individuals are of this group. Groups A and B can receive from their own respective groups a nd from group O . Approximately 40 per cent. of individuals belong to group A and 10 per cent. to group B. Group 0 can give blood to all four groups and is known as a universal donor. [t can only receive from group 0 and approximately 45 per cent. of individuals are of this group.

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FIRST AID &

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Beaders-J Queries Answered by Dr. A. D. Belilios D. R. (Monmouthshire) writes:- . Would you be kind enough. t.o give a ruling in respect of P?SltIOI1 of patient to be .transported Tn case of fracture of sp1l7e. The present textbook (page 124) says in all cases of Facture of spine. patie:1~ must be transported in supl71e posltzon. . Yet local doctors when lecturing to first aid classes say, in cases. of Facture of spine below cervzcal region, the patiellt should. ?e transported in the face down posltzon. I should be very grateful for your opinion on this matter. Answer Dr. Belilios replies to your query as follows: 'Methods have changed in the course of years, hence the opposite views which you have received. At the present time, however, I feel we must be guided by the S.J.A.A. manual and stick to the ruling that all cases of fractures of the spine must be transported in the supine position.'

w. C. (Wimbledon) writes:I was recently in rather a quandary • when I found a boy of 11 on our common so severely cut by glass on his thigh that a flap of skin had been raised. The wound was dirty and obviously needed hospital attention. I soon stopped the bleeding by the pad and bandage method and then told the boy I lVould take him to hospital (about a mile away). The boy, however, protested and asked n:e to take him home (about ~ a mzle away). This I did but feel I wasted time since I heard afterwards that he had to have eleven stitches. 1 wonder whether I should not have trusted my own judgment and called an ambulance or taken him straight to hospital.

Answer I think you acted correctly as you had dealt with the emergency and presumably advised the parents to

take the boy to hospital. Technically putting in stitches is an op~ra tion and in the case of a rrun~r requires the parent's co?-sent. ThlS is still more important If an anaesthetic is required. Moreover, the parent's presence is reassuring for the child and helpful to the doctors, e.g. they will be .able to ask if t.he patient has preVIOusly had an Injection of antitetanic serum.

pressure but we have noli' b~en told that this is incorrect. For thiS reason l~'e shall be very grateful to hear other views. Answer You must avoid direct pressuredigital or by pad and bandagewhen there is projecting broken bone. In other cases, direct pressu re can be used.

J. C. M. (Woking) writes:---:. Under the section entItled Dzsplaced Cartilages of the Knee, the S.J.A.A. manual refers to the semilunar cartilages. I should be grateful If these could be briefly explained.

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Answer The upper end of the tibia has two hollows into which fit the rounded condyles of the lower ~n~ of the femur forming the knee JOInt. The hollowed surfaces of the tibia are two deepened half moon shaped pieces of cartilage-the internal and external semilunar cartilages respectively-which also act to a certain extent as buffers between these two strong bones. C. F. (London, E.3) writes:. Would you kindly give any ruhng, if you kp'J1V of one, on the following subject. With reference to the Amendments in the 40th Edition of the St. John~s Handbook, page 118, Fractured Skull. General Rules for Insensibility, page 162, and Concussion and Compression, pagp 165. The instructions tell us what to do , when breathing is obstructed, but not, what to do ~f breathing is not 0 b- . structed. Could you please give the treatment that is generally accepted in the St. John Ambulance Brigade, particularly for competition purposes. Answer In my view, the answer tur.t~s largely on the rule ' ensure that aIr can enter freely into the lungs.' This will generally mean that the patient lies on his back wit~ the head if possible, turned to one SIde.

1. G. W. (Manchester) writes:We in our Division, are a little doubiful about the correct first aid to apply for wounds accompanied by severe haemorrhage when there is also a fracture present. Up till now we have avoided any kind of direct

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New Industrial Medical Centre by Sir George Barnett, Chief Inspector of Factories, recently, represents a furth~r stage in the development of the Company s medical service which began m 1919, when a qualified nurse was appointed to care for the sick and injured. Stanton Brigade Division .. The design of the new bmldlng takes account of the development and improvement of hospital facilities sinc~ th~ advent of the 1a tional Health Service lil 1948. The more serious injuries are sent at once to hospital in the Company's own ambulance, but there remain many cases of socalled 'minor' injury where prompt treatment at work can prevent suffering and loss of earnings. To this end the Company employs a staff of State regi~tered ~urses and a chartered physiotherapIst, eqUipped with modern apparatus. Members of the Stanton Ironworks Division of the St. John Ambulance Brigade take over at weekends. Works accidents are not the only conditions treated. A man with skin. trouble of the fingers, for instance, finds It much better to have the fingers baD:dag~d properly at work tha~ to le~ve .thls dIStasteful task to his WIfe. InjectIOns and physiotherapy may be given at the general practitioner's request. The importance attached by ~he manag~ ment to the prevention of JlI-~ealth. IS illustrated by the new X-ray machme,. w.lth which the chests of new and ex~s~mg employees will be studied. In addltlon, photographs of skin conditions are taken for educational purposes. By means of lectures it is also hoped to teach safer working methods and thus prevent some of the injuries which tend to be regarded as inevitable in heavy industry. At Its malO works the Company employs roughly 6,200 persons. Each month about 3,9°0 items of service are given by the r:nedlcal department which ha~ been superVised by a whole-time doctor Sillce 1946. SOLUTION TO CROSS\VORD No. 25 (This issue's crossword is unaVOidably held over.) ACROSS . J, Gossip ; 5, Shinbone; 9, Bandl t; ~ 0, Pirate; 11, Inane; 12, Scheme; 14,. TropIC; IS, Admitted; 16, Scenic; 17, FIllet; 19, Griffins; 21, Severe ; 22, Panels; .23, Satyr; 24, Posset; 25, Emetic; 27, Bllsters; 23, Sister. DOWN 2 Ova' 3 Sudden iUnesses; 4, Patient; 5, Scraped; '6, Impetus; 7, Bur~ on~'s fingers; 8, Nutrition.al; 13, Cod hver 011; 18, Trestle; 19, GlottIS; 20, Impress ; 26, Ice.

HOBSON & SONS (London) UNIFORM CLOTHING AND EQ UIPMENT MANUFACTURERS 154 - 164 TOOLEY STREET LONDON BRIDGE S.E.1 'Phone:

Hop 2476 (4 lines)

'Grams:

"PLASTIFOL"

E.S.P. TRAINING MODELS Is your Unit equipped with The ESP MINIATURE SKELETON? 26" high, scale model of the human skeleton .

" Hobson, Sedist, London"

PLASTIC

WOUND

REPLICAS

Write now (or details o( this and other valuable training aids including: SCULPTURED SKELETON (FULL SIZE) MINIATURE DISSECTIBLE TORSO MOTHERCRAFT DOLL HUMAN EYE HEART, EAR, ETC., ETC. Prompt attention to al/ enquiries. I/Iustrated brochure (rom Sole }lanuIacturers :

EDUCATIONAL & SCIENTIFIC PLASTICS LTD. 71 Brighton Road, Hooley, Coulsdon, Surrey Tel: Downland 24C2

Miscellaneous Advertisements should be sent to First Aid & Nursing, 32 Finsbury Square, Lond::>n, E.C.2.

Rate 4d. per word, minimum 6s.

Box numbers Is. extra.

SCENT CARDS. 250 18/6, 1,000 52/6. Tickets, Printed Pencils, Memos. Samples [ree.-TrCES, 11 Oaklands Grove, London, W.12. S. J. A. B. Badge Wall Shields, 26s. 6d. S. J . A. B. Gold cased crested Cuff Links, 50s, S.J.A.B . Badge Ladies' Brooches, 21s., Trophy Shields supplied. Medal ribbons 9d. each on buckram for sewing on uniforms, Is. each ribbon if mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for leaflets. - Montague Jeffery, Outfitter, S!. Giles Street, orthampton. OUR NEW series of First Aid competition papers are now ready. Team tests 5 for 5/-. Individual tests 8 for 5/-. Selby & Plowright, 135 Russell Street, Kettering.

FOR

FIRST

AID

EXERCISES

Casualty faking using putty and grease paint has played an important part in First Aid training during recent years. Although very effective, the difficulty is that a considerable amount of time is spent in modelling the wounds and they are ultimately destroyed when treatment and bandaging take place. The new Plastic Wound Replicas are made of soft plastic material which is washable and lasts indefinitely. They can be temporarily attached to the skin _ with gum and used over and over again. It should be emphaSised that the Plastic Wounds are perfect replicas of the wound and cannot be detected from the real thing. The use of these will add zest and a new interest to trai ning, competitions, etc. Wound may be obta in ed, postage paid, by sending a Postal Order for 2 -.

BROWNING'S LABORATORY & SUPPLY CO. LTD. Dept. WR 'fA., 69 Aberd een Street, HULL.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1956

FIRST AID & NURSING,

Nineteenth Edition. Completely revised. 261 st thousand. 286 pp., 286 illustrations, some coloured, 6s. 6d., post 4d. WARWICK AND TUNSTALL'S

GARROULD'S

AID

FIRST

TO THE INJURED AND SICK Edited by A. P. GORHAM, M.B., Ch .B., ~.R.C.S. Police Surgeon . City and County of Bmtol

'FIRST AID' WALL DIAGRAMS 26 X 40 in.

OVEMBER/DECEMBER 1956

for the

A Doctor - pa tie nt, writing of h is ow n case , m akes spe cial men t i on of the Sani tary Chair. This article, in w hich he we lcomes its introdu ction, quotes us as the suppliers .

-_ _._------_. ..._._--METHODS OF ARTIFICIAL RESPIRATION

A-G A natomy an d ph ysio lo gy. H-J The t r iangu la r band age . K. L T he roll er band age. M, N H.emorr hag e and wounds . 0 , P Dislocat ions a nd fractures. Q , R T ranspor t. 5, T Artificial resp ir at ion .

Single Sheets : Linen - 75., plu s posta ge . Pa pe r - 55., plus postage . Set of 20, on Roller : Linen - 1505., post free. Paper -I OOs. , post free . T he Briti s h Re d C ross Soci ety have specia ll y adopted a se t of 6 sheets, A, D, M, N , 0 , P, w hi.ch ca n be supplied on lin e n With fitt ings for t he spe ci al price of SOs., pl us postage .

Regula.tion Unifornt for

"I 'could not, however, escape the ~se of a bedpan, and this antiquated instrument, which has been hated by so many patients, and the drawbacks of which were greatly aggravated in my case, was one of the penances of my life. I am glad to know that it is already being displaced in many of our geriatric hospitals by ambulancy and by the sanitary chair." With acknowledgments to 'The LANCET,' July 7th, 1956.

OFFICERS

MEMBERS

OF THE

ST. JOHN AMBULANCE BRIGADE We have specialised in the making of Nurses' Uniforms for nearly 100 years and ha ve a reputation for good quality materials and superb workmanshlp. You can order your St. John Ambulance Uniform with confidence, knowing [hat every detail will be in accord.ance with regulations.

Please write for detai/s _ _

We shall be pleased to send full details upon request.

G. McLOUGHLIN & CO. LTD. Dept. L.F.A., VICTORIA WORKS, OLDHAM RD., Tel' ROCHDALE, LANCS. RodJda/e48977

JOHN WRIGHT & SONS LTD., BRISTOL

& (Female only)

150-162

EDGWARE

ROAD,

LONDON,

W.2

BAILLIERE BOOKS FOR FIRST AlDERS A HANDBOOK OF

E,LEMENTARY NURSING Arthur D. Belilios, M.B ., B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N.

THE

HUMAN

Illustr at ed is our most popular assortment of such dressings (Adaptopruf No. M207) consisting of 114 adhesi ~ e plaHers of five d ifferent si ze s. Each has a dressing pad of soothing. qUick healing Euflavin e , a most effective medicament equa lly for wounds and burns. W henever a waterproof plaster is not essential we r ecommend Adaptoplast First Aid Dress ings be used . A PRODU C T O F

_L<

~;,d

CuX$'(1H. QVVl1!'c:.itd.

OLOBURV

SIRMING HAM

FOR

SKELETONS

Articulated and Disarticulated. HALF SltELETONS, Etc., Etc.

Waterproof First Aid Dressin~s are intended for use when a wound IS exposed to water, or contamination from oil, dirt etc., ' and where necessitated by hygienic requirements.

PIONEERS OF INDUSTRIAL FI RST AID

HOUSE

ADAM, ROUILL Y & CO. Human Osteology, Anatomy, Etc.

ESTABLISHED 1878 'Phone BROadwell IJSS

18 FITZROY STREET, FITZROY SQUARE, LONDON, W.1 TELEPHONE:

MUSEUM 2703

This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. It describes in simple language the basic principles and procedures that underlie the science of nursing, and contClins brief descriptions of the more common diseases, with general notes on the nursing required in each case. A complete chapter is devoted to tbe subject of home nursing, and the whole book provides for every first aider the essentials of nursing in handy yet comprehensive form.

ith 314 pages and 57 drawings 8s. 6d. Postage 9d.

BAILLIERE'S HANDBOOK OF

FIRST AID AND BANDAGING by Arthur D. Be]j)jos, M.B., B.S ., D.P.H., D. K. Mulyany, M.S., M.D., F.R. C .S., F.R.C.P.r., and Katharine F. Armstrong, S. R . . , S.C.M. First aid books, as a rule, con fi ne themselves to inj uries, e.g. fractures, wounds, burns, scalds, etc. This volume is fa r wider in scope. It co\ er ~ medical conditions of all kinds, and much of the information is not to be found easily elsewhere. There are chapters on case-ta king, med ical causes of unconsciousness, internal haemorrhage, first aid in materni ty cases, first aid in spinal injuries, asphyx ia, indust ria l poiso nin g, the use of morphine. 'Undoubtedly tIle best of its kind.' !\'ursillg i\lfirror. Fourth Edition. With 488 pages and 200 drawings. 81'. 6d. Postage 9d. Bailli~re, Tindall and Cox Ltd. 7-8 Henrietta Street OR

Dale, Reynolds and Co. Ltd. 32 Finsbury Squa re

London, W.C.2

London, E.C.2

Please send me { ............. ........... copyjies of A Handbook of Elementary Nursing copyj ies of First Aid and Bandaging for which I enclose remittance of. . .. . ......... ' .. .. (Postage 9d. extra per vo lume .) Name ........ ... .. ..... . Address ............. .............. .

T AID

A NEW ALL-METAL 2-STRETCHER AMBULANCE ON THE LAND ROVER I 07 in. W /B CHASSIS

&: NURSING JANUARY/FEBRUARY 1957

THIS up-to-date ambulance incorporates the latest aluminium alloy constructi on techniques to combine toughness with comfort, and has all the mobility and tenacity afforded by a 4-wheel drive. The design prOVides for two stretchers and an attendant, one stretcher and three ::.ltting cases, or six sitting cases. Features include built-in wash basin with water supply, fully insulated body for tropical use, and adequate locker accommodation. You are invited to apply for full details of Mobile Medical Units, Ambulances, etc., built to your particular requirements for service in any part of the world.

PILCHERS

AMBULANCE & MOBILE UNIT BUILDERS

314 Kingston Road, Wimbledon, S.W.20 Telephone: LIBerty 2350 & 7058

47 High Path, London, S. W .19 Telephone: LIBerty 3507

SKIN INFECTIONS are primarily caused by Staphylococci, Streptococci and B . Pyocyaneus . A really effective ointment must therefore strike at these micro-organisms.

PRICE FIVEPENCE 3/6 per Annum Post Paid

ANTIPEOL CUTANEOUS OINTMENT is a prepara-

tion which incorporates the sterile broth filtrates of the three infective microbes in an ointment base of proved efficiency furth-er to accelerate the process of rapid bealing. for burns and scalds, ANTIPEOL OINTMENT is both non-adbesive and AS

TREATMENT

ANTIPEOL is therefore an essential component of every First Aid and Nursing Kit.

Printed by HOWARD, ] ONES, ROBERTS & LEETE, Ltd., 26-28 Bury Street. St. Mary Axe, London, E.C.3, and published by the Propnetors. DALE, REYNOLDS & Co ., Ltd., at 32 Finsbury Square, London, E.C.2, to whom all communications should be addressed.

FIRST AID & NURSING, JANUARY/FEBRUARY 1957

GARROULD'S

Nursing

for the

Regulation Uniform for

OFFICERS

First Aid

Editor: Peter I. Craddock

MEMBERS

(Female only) OF THE

ST. JOHN AMBULANCE BRIGADE Established over 100 years =====================ill

E. & R. GARROULD LTD. ~==================~I LONDON,

\v.2

, PATENT

"PORTLAND" AMBULANCE GEAR

The Gear iIIustrated(A. B.C.D.} carries two stretchers on one side of Ambulance, leavi ng other side clear for sitting patients.

a serious handicap to the national economy. In one year eighteen million man-days have been lost through industrial accidents. One way of tackling this vital problem of loss to industry through absence due to accidents is the establishment of an efficient first aid organisation to supplement any other medical arrange-

Diseases oftheDigesti ve System

Artificial Respiration for Two Victims

Casualties Union News

Can We Reduce Road Accidents

Competitions

First-Aider's Crossword

ments which may exist , since early treatment on the spot can materially reduce the period of absence . The St. John Ambulance Association,

Readers' Queries

February 21st March 27th April 4th

no you know

that • •• Out of every hundred, 95 babies are born with dark hair ?

A. Shows the two stretchers in position.

A large colony of microscopic plants, mostly fungoid, Lines a pa rt of the walls of the small intestine ?

C. Illustrat es the same Gear with the top stretcher frame hing~d down for use when only one stretcher case is carried. D. Shows the same position as in .. C " only with cushions and back rest fitted for convalescent cases.

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

The capacity of the bladder of a normal adult js, approximately, 14 fluid ounces, but when full y distended is capable of holding 24 fluid ounces? At a Conference between the medical profession and the Sf. John Ambulance Brigade, held in 1887, it was agreed 'that a proper system of transport of invaJids in the City of London' should be esta blished? A normal adult can tolerate the loss of two pints of blood without danger to life ?

Full catalogue of Ambu lance Equipment No.7A will be sent on request.

65, WIGMORE STREET, LONDON, W.I 'Phone: WELbeck 0071 (Late GREAT PORTLAND STREET)

A new-born expires?

babe inspires

before

the St. Andrew 's Ambulance Association and the British Red Cross Society already organise first aid courses for workers in industry, and they have now prepared courses in occupational first aid to enable the best use to be made of the men so trained. Certificates will be issued to candidates successful in the examinations held at the end of the course. To mark the publication of the new authorised textbook on Occupational First Aid, sponsored by these three organisations, a reception was held at St. John's Gate, Clerkenwell , recently.

F orthcoming Eyents

From a Seat in the Audience I [

The UP AND DOWN action is quick and easy for loading or unloading. B. Shows the top stretcher lowered read y for loading.

First Aid in Industry

THE heavy toll of accidents in industry is

In this Issue

We shall be pleased to send full details upon request.

ROAD,

tinguished military career. Before and dur.ing the war, he was in Military 1nteillgence and attended the Washington 1st Quebec, Cairo and Teheran Conierence~ on the Staff of the British Chiefs of Staff. In 1944, he was on the staff at Salisbury during the launching of operation ' Overlord'; and then was appointed Chief of Staff to the British Forces in Greece and subsequently in Palestine. ' In 1948, General Kirkman became Chief of Staff, Land Forces Far East, until 1950 when he took up the post of Chief of the Intelligence Division in Germany. He retired in 1954. T~e new Commissioner-in-Chief hopes to VISlt tbe St. John Ambulance Brigade both at bome and overseas within the near future.

Textbook on occupational first aid- a joint enterprise

You can order your St. John Ambulance Uniform with confi~ence, knowing that every detail will be in accordance with regulatIons.

EDGWARE

Major-General John Mather Kirkman, C.B., eB.E. , has been appointed Commissioner-in-Chief of the St. John Ambulance Brigade, by H.R.H. The Duke of Gloucester, Grand Prior of the Order of St. John. General Kirkman has long had an interest in St. John, for when he was Chief of Staff to the British Forces in Palestine he vi sited many of the scenes of th~ Crusades where the Knights of St. John gained such fame . General Kirkman follows the late Sir Otto Lund as Commissioner-in-Chief of the St. John Ambulance Brigade. It was Sir Otto who first approached General Kirkman to join his staff on the St. John Ambulance Brigade. General Kirkman had a highly dis-

January/February 1957

We have specialised in the making of Nurses' Uniforms for nearly 100 y~ars and have a reputation for good quality materials and superb workmanshlp.

150-162

New St. John Chief

Police National, Porchester Halls, Bayswater. British Electricity, Porchester Halls, Bayswater. Metropolitan Women Police Final , Percy Laurie House, Putney . Aprjl 11th Women Police (Gracie Lucas Cup), Percy Laurie House, Putney. G iris' Life Brigade (Inc.), London. May 18th Distillers ' Company Ltd ., Conway Hall, Red Lion Square. Ma.y 30th B.T.C. (Railways and Docks) and B.T.C. Police, Central June 5th Hall , Westminster. Ministry of Supply, Central Hall, Westminster. June 21 st ational Dock Labour Board, St. Mary 's College, London E. July 6th Casualties Union, Regional Eliminating Rounds. July 7th SJ.A.B . Finals (Dewar and Perrott), Central Hall, WestJuly 13th minster. N . H.S.R. Mobile First Aid Finals, Sophia Gardens Pavilion, July 20th Cardiff. September 13th National Fire Brigades, Southport. Casualties Union , Final Competitions, London University October 6th Sports Ground, Motspur Park. G.P.O., Porchester Halls, Bayswater. October 23rd Dock and Harbour Authorities, Weston-super-Mare (to be November 6th confirmed. ) November 14th Grand Prior's Trophy, Porchester HalJs, Bayswater. The dates for the following have yet to be fixed: United Kingdom Atomic Energy Authority, Gas Industry and ational Road Passenger Transport.

FIRST AID & NURSING, JANUARY/FEBRUARY 1957

A Course in Elementary Medicine

Diseases of the Digestive System

HESE articles are being devoted to a description of some of the commoner ailments that affect the human body and for tbis month we have chosen the digestive system which begins, of course, with the mouth.

Stomatitis The suffix 'itis', so common in medical language, is used to denote inflammation of the organ concerned; thus, bronchitis-inflammation of the bronchi, tracheitis-inflammation of the trachea, etc. There is, however, one exception to the rule, namely' examinitis ' which affects students just before they take an examination! Needless to say, the symptoms are quite different! Stomatitis, therefore, is inflammation of the mouth since ' stoma' is the Greek word for mouth. It is a common condition of which there are several important types. Acute Catarrhal Stomatitis This produces swelling and redness of the red lining (mucous membrane) which covers the inside of the mouth. It may be accompanied by dryness and difficulty in eating. Sometimes actual ulcers, small in size, may be seen. The causes of the complaint are numerous. It may result from the irritation caused by poisons, e.g. irritants while sometimes oversmoking is the cause. In children, it may be a complication of a digestive disturbance associated with cutting teeth or it may occur during the course of an infectious fever such as measles. Thrush This variety of stomatitis is due to a fungus and is characterised by the formation of small white patches surrounded by a red margin on the cheeks, tongue, gums or palate. It occurs most commonly in weakly infants particularly when scrupulous cleanliness of the teats of feeding bottles has not been observed. But it also affects adults who are seriously ill, especially

By A. David Belilios M.B., B.S. (Lond.), D .P.H. (Eng.) when there is failure to use mouth washes regularly. As those who have studied elementary nursing are aware, the care of the mouth is of great importance in many illnesses. Gingivitis

This is the name given to inflammation of the gums , which may become soft and spongy, bleeding easily if touched. The complaint can be caused tbrough a germ and may be intensely infectious. A chronic form of infection round the teeth is very common after middle age although sometimes it occurs in younger people. It is known as pyorrhoea and affects particularly those who have neglected dental hygiene. The gums become soft, the teeth loose and yellowish-white pus can often be seen at the junction of the teeth with the gums. The condition may affect the general health of the patient and often the patient has to lose his teeth. Gastritis This is inflammation of the mucous membrane which lines the stomach. It may be an acute or chronic ailment. Common causes of the acute variety include ingestion of bad food, unripe fruit, excess of alcohol and the various groups of irritant poisons such as non-edible toadstools, bad food, etc. Some cases are due to an infection with a germ or virus. The patient suffers from pain in the upper part of his abdomen and often vomiting; blood may be brought up. Often the condition extends to the intestines, becoming gastro-enteritis in which event there will be griping abdominal pain accompanied by diarrhoea. Chronic gastritis may result from recurrent attacks of the acute variety and in addition may be due to many other causes including hurried or irregular meals, imperfect chewing due to bad or deficient teeth and continued alcoholic excess. The

patient suffers from loss of appetite, flatulence and other symptoms of dyspepsia. Peptic Ulcer This term is now used to include the cornmon diseases of gastric and duodenal ulcer because they are similar conditions. Ulceration is produced by erosion of the mucous membrane and this process may extend both in surface extent and depth, penetrating in turn the four coats of which these organs are composed. Peptic ulcers may be acute or chronic - the former beginning suddenly, progressing rapidly, and healing with treatment quickly although they may be liable to serious complications. Chronic ulcers develop more gradually and are difficult to heal; sometimes they remain stationary for many years and require an operation for their cure. Gastric Ulcer The sufferer from a gastric ulcer complains of a dull aching pain in tbe upper part of his abdomen. It develops soon after taking food and continues until the meal has left the stomach. The pain is made worse by taking further nourishment but is relieved by vomiting should this occur. Owing to the recurrent pain the patient becomes afraid to eat and loses weight. On appropriate treatment, these symptoms are quickly relieved and the ulcer may heal up completely; relapse, however, is not uncommon and complications may arise. If, during its growth, the ulcer erodes a blood vessel severe haemorrhage from the stomach results and is called haematemesis. The patient vomits a variable quan(ity of dark red blood, often partially clotted and mixed with food. If the blood has remained in the stomach for some time before vomiting occurs, it usually resembles coffee grounds ill appearance. Severe shock accompanies a haematemesis.

FIRST AID & NURSING, JANUARY /FEBRUARY 1957

First aid for this complication is well-known. The patient should be kept lying down with hi head and shovlders low and his feet raised. Pillows should be removed. He should be advised to relax as much as possible since complete rest is essential to keep the bleeding to it minimum. Shock requires treatment but no fluids may be given by the mouth in case they dislodge the blood clots which are assisting the natural arrest of the haemorrhage. Careful ob ervation must be kept on the rate and trength of the pulse which is a guide as to whether the bleeding has stopped or is continuing, A doctor' help is most important. for he can give an injection of morphia or similar drug which will help to control the bleeding. He may al 0 arrange for a blood transfu iOll. If tbe bleeding continues despite the measures adopted by the physician, a surgical operation may become necessary, The ulcer, 'which is bleeding, together \\'ith part of the stomach may be completely removed, a procedure known as partial gastrectomy. Perforation of a gastric ulcer is an even more serious complication. In this event the ulcer erodes through all the coat of the stomach, the contents of which then enter the general abdominal cavity, This ets up inflammation of the inside lining of the abdomen called the peritoneum and peritonitis results. Perforation of an ulcer occurs suddenly the patient being seized with intense abdominal pain. Vomiting follows and there are many of the usual symptoms and igns of hock, A characteristic feature is that the patient automatically adopts a position which gives him mo t relief from the pain. This is lying on the back with the knees bent, the shoulders raised and the arms often a bove the head. It will also be noticed that breathing is shallow and is undertaken chiefly by the chest: movements of the abdomen are as restricted as possible. Pressure on the abdomen causes the patient increased pain and should therefore be avoided. A doctor has to feel the abdomen gently in order to confirm hi diagnosi since when perforation has occurred all the muscles become stiff or 'rigid' as

the sign is called in medical language. Medical aid is urgently required a,nd the patient will need an operatIOn so that the perforation can be sewn up, Duodenal Ulcer This is ery imilar to the ~astric variety except that it occurs III the duodenum. It may be acute or chronic, The chief ymptom is a dull gnawing pain in the upper part of the abdomen and on the right side. It is noticed some time after a meal -perhaps t\\ 0 to three hour -and therefore begins when food which has been digested in the stomach leaves this organ and enters the duodenu m. Thus the pain tend to occur a short while before the ne,t meal is due and hence is often called 'hunger pain' particularly ince it is relieved by ta king food. A peculiarity of a chronic duodenal ulcer is its tendenC) even over a period of many years-to get apparently better for an interval only to relapse again after a time. The main complications are perforation and haemorrhage. The former gives an almost precisely similar picture to that of a perforated gastric uIcer and a similar treatment is adopted. Bleeding, however, though caused in the ame manner, shows itself differently, the blood not usually being vomited but passed by the rectum, when it is known as melaena. It will readily be understood that blood from the duodenum has a long journey to make through the small and large intestines before it leaves the body. For this reason it becomes considerably altered in its appearance by the time it ani, es at the rectum. It becomes ' tarry' in colour and consistency and it ha a very offensive odour.

Symptoms of melaena usually occur ome time before the patient passes the characteristic motions. They may include tho e of shock together with pallor, shortness of breath even on slight exertion and a quickened pulse which may be noticed as palpitations. First aid is very similar to that recommended for baemateme is.

Artificial Respiration for Two Victims A manual method of artificial respiration for the simultaneous resuscitation of two victims. A. L. Bennett et at. Abstract of Paper not available in this country.

THE meth<?d of artifi<;:ial ~espiration now

most \\'ldely practl ed lQ aU countries is that devised by Holger- Tielsen in Denmark. The authors have set themselves the problem of attempting to adapt this method for resuscitating NO persons at once with only one operator. a situation which might well be met \\ ith in an industrial or other accident. and whilst the would-be re cuer i making up his mind which casualty to treat first, one of the victims may have reached the ·point of no return' and the life lost because of indecision. For the application of this adaptation of the standard Holger- ielsen method, the victims are placed side-by-side in the prone position, Their adjacent arms are placed in an extended po ition above their heads and the two outer arms are bent so that, \\ hen their faces are turned outward, the head of each will rest on the back of the hand. The first aider then kneels astride the two outstretched arms and close to the two heads. Pressure is applied by placing one of his hands between the shoulder blades of each victim whilst rocking forward on his knees. Ha\'ing accomplished thi expiratory manoemTe, he grasps the outer two elbows and pulls as he rocks backward. After this inspiratory mo\'ement has been completed the elbo\\s are lowered and the expiratory cycle recommenced, The operation is repeated t\\'eh e times per minute. Using a total of 40 \'olunteer subjects, the authors found that the Holger- ielsen method was 96 ° ' 0 more efficient than the Schafer method from the point of view of increased tidal air flo\\ and the double method just described was 74 o~ more efficient than the Schafer compared in the arne way. It was, of course, to be expected that uch an operation would demand a higher energy expenditure on the part of the first aider and, in fact, it was found that for a given ta k of the same duration, 4.0 litres of oxygen were required abo\'e the resting level of consumption to carry out the Schafer method, 5.8 litres for the -Holger- ielsen method and 8.7 litres for the double method. The authors ha\'e actively concerned themselves with the po ibility of errors occurring in their mea urements due to the necessity of using conscious subj~cts, and objective criteria for the election of subjects is presented, The closing paragraphs are, quite correctly devoted to tbe p,roblem of the control of pressure applled WhICh has, in the past, resulted in some unpleasant occurrences sHch a crushing of ribs. £. J\J. Crotoll

Editor·s Note.-The question of applying A. R. to two yictims simultaneously is not a new one, and was discussed at the Surgeons' Conference, some ad \'ocating the attempt to ave two lives ,and so~e feeling that it be better to feel faul1:' certam of savina one than a chance of savlOg two. Then again, the question which. the first aider ha to decide is, . If one, whIch one?' It is a difficult problem.

FI R ST AID &

Passed 1,200 Mark

This of course does not mclude a large number of events, which due to the modesty of some groups, ar~ thought to be too small for the official records. It is at these small routine training sessions that the Union 's true work is done. The handling and treatment of one 'casualty', carried out several times. on the same occasion, enables the first alder to gain valuable experience, improve technique, and overcome weaknesses. We would like to be told about all the small events, please. C .S. Broadcast A representative of the ati~mal B~oad casting Company of Amenca, VIslted H.Q. to make a recorded interview for the Monitor Service of the United States. Comments and recorded excerpts of acting were made by Mrs. H. M. icholson , Mrs. 1. M. Gray, Mrs. K. Botterill, and Mrs. T. Mitchell, with special emphasis on the interest of Casualties Union to women. Our senior instructor in South Africa (Mr. T. Behrens) was recently flown b.y the S.A.A .F. from Cape Town to Pretona, to run a course on casualty simulation for one week, at the South African Army Medical School. Personal Experience How much bruising, swelling and pain is present immediately after an injury? How often we have all argued this point. We are sure this first hand account of one of our Altrincham Branch members will be interesting and helpful:I had a bad fall at 9 a.m. at the front door, having slipped and fell, striking bot.h shins and knees on the edge of a rustIC brick step and the iron grating door mat and hitting the house wall, head on. For the first few minutes the pain was so agonising that I said 'leave me, ' to my father who came to help. After a minute or two, when the pain became bearable .. he helped me into the house, though feelmg faint and ghastly, I thought: 'I must see what my legs look like for c.u.' On one shin near my knee I had definite swelling the size of a walnut, lower down, bruising over an area of 2-3 inches (blue grey) and a swelling the size of a large egg. This was all present in under ten minutes. Fortunately I had on thick stockings and cuts and grazes were slight. The small lump disappeared in about an hour, the larger one by night time, leaving severe bruisingand pain. The other pai ns which appeared all over my body later were just nobody's business. When I was able to get up and walk to the mirror, my face was pale, and this lasted about an hour. O n Being Prepared It would seem that' Be Prepared' is the motto not only of the Boy Scouts, but also of the Casualties Union for in my first experience of their work, in connection with Civil Defence, I was

U R Y FE BRUA R Y 1957

Confessions of a Competition Casualty . . .

Casualties Union News first time the UnIon has :p~s~ed P ORthethe1,200 mark for the year's actlV1tIes.

U R s r G, J

particu larly impre ed by the thorougbness of their preparation as well as by the ob\'ious enthusiasm of their members. In the teaching of nurses, whether in nrst aid general nursing or in any other field th~ work of the Casualties Union could, I feel, be of great value.. The realism portrayed seems to my rrund, to be an essential factor in this and although there may be differences of opinion regarding the degree of makeup necessary, as a nurse tutor, I.think it should be as near to the real thmg as possible. The very fact that the casualties look the part, provides a stimulus to a nl;lrse and encourages her to treat the patIent with the degree of urgency, gentleness and sympathy required. 0 amount of dealing with dummie , diagrams and paper models can arouse the same interest nor teach as much . ot all hospitals have a casualties department and in any case, only a small percentage of the staff can be employed there for any long perio.d, so that experience with real casualties IS limited. Co-operation of teaching departments with the Casualties Union could benefit both greatly, with wars and rumours of wars so much in the air, what better way of being prepared cou ld there be? For my own part, I look forward, with pleasure, to any future meetings with the Casualties Union and recommend anyone not aware of their interesting and helpful work-and if teaching any branch of nursing-to avail them selves of their valuable help.

Winifred M. Rhodes (Sister TUfor) The occasion to which Si ter Rhodes refers was Exercise 'Alpha " Cheshire D ivision Civil D efence Corps. Altrincham Branch and Study Circle 35 provided 14 casualties. The injured were treated by .H.S.R . mobile first aid units, manned by doctors, sisters and auxiliaries, treatment was very thorough and realistic, wounds were stitched and drip needles and injections were actually inserted into the casualties. Buxton T rophy Entry forms for the Buxton Trophy O pen Competitions to be held at Motspur Park on 6th O ctober (see' Forthcoming Events ') are now ready, and applications for these should be sent to Miss A. F . Murphy, Competition Secretary, 9, Wimborne Way, EImers End, Beckenham, Kent. A further interesting comp etition has been added this year, for which the Jarvis B owl will be awarded. It is for the purpose of stimulating the study of the rescue of an unco nscious person. A man-hole will be constructed o f transparent materials in order that j udges (doctors a nd engineers) can observe th e methods used by competitors. Full p articulars of this, and the other competitions, can be obtained from the Competition Secretary,

I hape been a first aider for years, but /lOW that I am a trained casualty 1 hm'e discol'ered that:Tight bandages can hurt iIorribly. lr i. very annoying to be told to 'lie still' lI'hen olle is pinned down by two broken legs under a motor cycle. Hall' easy it is to make a casllalty choke in uil'ing them a drink from a water baffle. What torture it can be, to be placed on top of an ants nest, when .1'011 are supposed to be unconsciolls. Hall' thirsty I could feel, )I'hell one finds Ollt there is no tea left by Ihe time the casualty has finished c/eallin u up.

. . . And Suggestions S tretchers . Could stretchers be placed ill a belfer position on the trestles? It is very uncomfortable and often I'ery paillful to fie on a stretcher with the trestles pressing imo olle's head, back. chest or othe" par' of the bodl'. Equipm ent. There seems to be a shortage of blankets and pillow material. Requests for 'something under 171.1' head' are often ignored or when provided, IIncomfonable or painful in I'iew of the supposed injury. T rea tment. Generally speaking, the treatment is adequate in l'iew oj' Ihe fact that a doctor and trained nursing assistant comprise part of the team but we do encounter a good deal of roughness and we seldom escape some bruises and el'el7 scratches alld strained muscles! First-aiders stit I seem to lack the gentleness and imagination required in dealing with sick and injured people. We feel that Casualties Vnioll has not yet aclzie)'ed the satisfaction of bringing out the human qualities in The first aider. Too much patting and pulling of the limbs and body, which often has painful reaction 017 (he injured part. R eassura nce. This is sllch a I'ery important part of Ihe work and is not too good. The phrase' There, there, you are quite all right, don't 1I'0rry,' does /lathing 10 quell the worry and anxiety of the patientprobably nearly frantic about relatil'es, a broken appointment, or allxiel), re his her job Through maiming, etc. The absence of the first-aider for a few millutes supposedly dealing with a message on tir e abol'e matter, and a return with a firm confirmation of action taken, would go a long wa)' towards comforting The patient. Doctors: The doctor could help more in this reassurance: also when casualties are given an injection, if the doctor JIIould teff the patient (if conscious) what lie is doing and gil'ing, or lell the first-aider in the casually's hearing-stating Ihe effect and time factor-it would help Iremendollsly in the casualty's reaction and subsequent acting. T he doctors, I am sure, are sometimes misled by the first-aider's descriptions of the casuaLties' signs and symptoms, and the doctor would benefit by getting rOl/lld to each one rather more quickly-even if ollly for a preliminary look. C hest as writing table. Please, it is so painful (when unconscious and IInable to protest) to have one's chest, or ill fact any part of the body, used as a writing table, or to have elbows dllg into one while the firs/aider falks! Continued opposite

F IR ST Al D &

U R SI

G, JA

VARY/FEBR UA R Y 1957

Can We Reduce Road Accidents ? L AZI G idly in a deck chair on Brighton front one sunny afternoon (how few they were la t year-sunny afternoons . not deck chairs!) we were suddenly startled from our reverie by the sound of a coach horn. Turning towards the road , whence the sound appeared to come, we sat up and rubbed our eyes. Had v,:e been transported back a century? There, before us, travelling at a leisurely pace and drawn by four beautiful bays, was a stage coach (which wc learned afterwards was 84 years old), on the top of which were passengers in the costume of the period. Vainly our eyes searched for the portly form of Mr. Pickwick or young David Copperfield, and we would not have been surprised if the door had opened to allow of the exit of these two worthies. However. they did not appear!

THE EXPLA.'1ATIO N The stage coach was being used by the R oads Campaign Council, who e headquarters are at 15 Dartmouth Street, London, S. W.1. to pub I icise their campaign for better planned and constructed roads. The scheme was launched on 5th April last. and by the end of September had conducted campaigns in 24 of our largest cities and towns. Daylight cinema van show films demonstrating traffic problems, mobile exhibitions display models, films, photographs and maps, and illustrated pamphlets are being distributed urging all to sign the petition for imprO\ed roads. It will probably be asked, . What has this to do with first aid?' This question is adequately an wered in a bundle of literature which was sent to us a few days afterwards by the Council, and which certainly provided food for most serious thought. We must frankly admit that we had never before realised to ",hat extent our present antiquated. road ~ystems ,contributed to the ever Increasmg aCCIdent rate recorded annually by the various bodies computing and issuing statistic. We were reminded that on 6th May, 1946, a ten-year road development programme wa announced in Parliament by Mr, Alfred Barne , then Minister of Transport, but today, ten years later, when the plan hould have been translated into roads, not one mile of motorways has been built, and the amount of modernisation carried out on

Casualties U ni on-Continlled No risin u from the dead. Casualties are supposed t:; act lIntil rt~!?hl off the 'set" and we are real/v not sllpposed 10 rise /rom the dead or IInconsciolis state to ansll'er qllestiolls/roll/ the jlldge as to hall' we consider we hal'e beell treated. Of COllrse, If we are cOllscious and able to speak, we can do this-colltilluing to act ollr part. Don ' t cut our clothes. !vIay we suggest that team. are illstl'llcted IIOt to Cllt clothing if it can possibly be al'oided? If an in/llry is hidden, we make it po sible for the firstaider to find it. We are getting lIsed to being undressed- to a poifit-lI'hi~h is oftell necessary; but cllttillg can SOll7ellllle prol'e all embarrassment!

the existing trunk roads has been negligible. In those ten years traffic has increased from 3,110,000 vehicles to 6,500,000. and road casualties have increased from 162,546 killed and injured to 267,922, truly appalling figures. Included in the bundle of literature sent to us by the R.C.C. was . Basic R oad Statistics,' compiled by the British R oad Federation, and the analysis of figures representing road accidents resulting in deaths and injuries was truly startling. The two first numbers of Highway Times. the quarterly organ published by the Council contained most interesting accounts of road impro\'ements which had been made abroad, and which had been folJo.\'ved by an immediate and remarkable reduction in road casualties. It is not our province to discuss the economics of any proposed road improvement scheme, nor are we concerned with tbe political aspects involved, but we feel certain that none will deny that in any project which has for one of its objects the preservation of human life, the costs should not be counted. It is for tbis reason that. although we appreciate that tbe Roads Campaign Council may haye other objects as well, the fact that one of its objects is the reduction of road accidents justifies us in giving it our full support. We are no\\ fully convinced that an improved road system will result in a reduction of road accidents now responsible for such heavy losses in life and limb. Report of Commiss ioner of Metropolitan P olice Two days after the receipt of this literature from the Roads Campaign Council we received from the Commi sioner of Metropolitan Police 'A Statistical Analysis of Road Accidents in 1955' for the area under his administration, and a study of these ngures proved equally appalling. As the Report covers more than 40 foolscap pages it would be impossible to comment upo~ eyen a small fraction of the ngures gl\'en, but the follO\\ in!)' extract from his summary are, indeed, ~artling in them elve-: 54,542 casualties in road accidents in 1955, an increase of 8.315, or I 00' O\'e r 1954. D eaths resu lting from road accidents were 674 in 1955, an increase of 63, or 10.3 °0 over 1954. Serious injurie were 9,117 in 1955, an increase of 1,292, or 16,5 0 0 O\'er 1954. The Commissioner comments that the worst day of the week for casualties generally wa Saturday. 34 more pedestrian were killed than in 1954, and 1,27 more were injured. 16 more pedal cyclists wer.e ~illed than in 1954, and 1,278 more were IDJured. , Skid-Lids' a re Essentia l Casualties to motor-cyclists, including motor-assisted pedal cyclists, increased by 2379. The Commi sioner remarks here that the proportion of pillion pass~ngers fatally or seriou ly injured wa les In the case of tho e wearing crash helmet than in those not weari ng cra h helmets, In

this connection First Aid and Nursing feels that it would not be out of place to congratulate the Daily Express on the strenuous campaign \\ hich that newspaper has been conducting to induce motor cyclists and their pa engers to wear this protecti\'e head-gear. Perbaps the most terrible revelation of all was that relating to children, and we quote his summar) in full: . O\'er 1.000 more children (445 of them cyclists) were killed or injured than in 1954, an increase of 14°". 50 child pedestrian were killed, 5 more than in 1954, and there were 4 more child pedal cyclist fatalities.' The Commissioner has not been content with a pure analysis of the figures but has added a most valuable commentaT) in which he lists the principal contributory factors in road accidents, based, doubtless, upon the obser\'ations and reports made by the members of his force. He i to be congratulated upon this. and we recommend a careful study of this commentary by all those \\"ho are interested in this \ital question. This review would not be complete without a reference to the part now being played by the Mini try of Transport and Civil Ayjation, and the broadcast on Tuesday, 4th September last. entitled . Mind That Child' by the Rt. Hon. Harold Watkinson, M.P., 'vIinister of Transport and Civil A\iation.

Book Review , Essentials of Physiology.' Tenth Edition edited and rensed by H, Hartridge and J. L. D 'Silva. Published by Longmans, Green & Co. Ltd .. 6 & 7 Clifford Street. London, "'.1. Price 36 - net. 506 pages. NE\V .editions ~f thi book appeared v,ith faIT regulanty about once every four years during the period between the t\\ 0 world wars, but in 1940 they stopped and no ne\v edition has appeared ince. owing to war and post-war condition, until the present day. When it wa written b\ its original authors, Professor Bai nbrIdge and Dr. Menzies. it \\a intended for the use of the ordinary medical student. large enougb to supply him with the fundamental kllowledO'e of phy iology required by his profes~on. but' not 0 large that it produced discouragement and boredom. Thi idea has been preser\,ed by the present editor and in consequence e sentials have been retained while non-es entials have been omitted. OwinO' to the large inten'al of nearly ixteen years since the la t edition. dra tic re\'ision has, of course, been nece sary in order to bring the text up to date. The entire contents ha been re\ ised and many chapters ha\e been completely re"ritten. There are many chapter in this book of direct interest to the reader \\ ho \\lshes to gain further knowledge: The Heart Beat. The Blood Pressure, The Lungs. The Control of Re piration. Respiration under bnormal Condition, Sen atIons. etc. This book \\'ould be suitable for the first aider' personal reference Ii brary.-an) question that might ari ~ on ph)'s~olo~n would be answered b) thl book \\ Ith ItS eas>, references to all aspects,

FIRST AiD & NURSl G, JA UARY/FEBRUARY 1957

FIR ST AID &

U R SING, JANUARY/ FEBRUARY 1957

Atomic Energy Authority Finals

Competitio"s Gas Industry National First Aid Competition This Report, unfortunately, had to be held over from the last issue of the journal. ONCE again Mr. Therm has demonstrated the versatility of his vast family, many of whom are able to add to their wide repertoire of achievements that of a thorough knowledge of first aid, a fact which they were able to prove at their Annual Competition held last year in the Conway Hall, under the auspices of the St. John Ambulance Association. As usual, the tests were stiff, but the teams came off with flying colours. For the benefit of our many readers who are interested an outline of the tests is given here. Team Test, set and judged by E. J . Selby, Esq., O.B .E., M.A., M.R.C.S., L.R.C.P., of Baling: The team is calling on a friend when they hear a crash from an inner room. They fi nd the husband, who has been decorating the room, lying entangled in collapsed ladders and staging. Injuries: Compound fracture of right leg, simple fracture of left arm, simple fracture of 6th, 7th and 8th ribs, deep cut, with severe haemorrhage, behind the ear. Dual Practical Tests, set and judged by A. W. Gilks, Esq., M.B., B.S., of London: Nos. 1 and 4, walking along a quiet street, see a man slip off the kerb. Injuries:. Simple fracture of left patella, graze on nght hand, shock. Nos. 2 and 3, also walking along a quiet street, see a man, who is carrying a heavy box, fall to the ground. Injuries: Abdominal hernia, fracture of left clavicle, shock. After the twelve teams had completed their tests the platform was cleared of scenery and prepared for the presentation ceremony, whicb was presided over by M.r. Horace F. Parshall, T.D., M.A.(Oxon.), Duector-General of the St. John Ambulance Association, under whose auspices the competition was held, and which had provided the Challenge Trophy and plaques. He was supported by Sir Harold Smith, K.B.E., Chairman of the Gas Council, . who was to present the awards, and the Judges. Mr. Parshall said that it was his pleasant duty once again to welcome Sir Harold, whose continued interest in the ambulance movement was well known to alL It was most encouraging to learn of the steady improvement which had taken place in first aid by tbe Gas teams during the past few years. 'We of St. John' he said, , will give you all the encourage~ent we can.' (applause). He would take that opp0r,tunity of expressing once again their great mdebtedness to the Associated British ~icture Corporation Ltd., for their contmued generosity in supplying and erecting the scenery, which enabled them to make the tests so realistic. He thanked the stewards, time-keepers, St. John-trained patients, make-up artists and all those who had given their time so willingly to make

\Vinners of the sixth annual Gas Industry National First Aid Competition, held at the Con"ay Hall, London are the l'Iorth Thames Gas Board Team, who are seen in action during their team test. M€mbers of the team are S. Jones (Capt.) R. McDaniel, H. A. Eatenton, E. T. Stephens and C. J. Paremain (reserve). the event a success. The judges, however, deserved special mention, for without the skill possessed by these gentlemen-and sometimes ladies - these competitions would not be possible. Not only this, the comments which they usually make on the ' work which they have been judging is always anticipated with keen interest, not only by the teams, but by all the first-aiders in the audience, fOT from these comments they learn so much. He asked Dr. Selby to give his comments first. Dr. Selby thought that the teams had heard enough of him that day, but he wouJd impose upon them a few more remarks. The theme of the test this time had been haemorrhage, and he would like to have seen them get on to this with less delay. He could not lay too much emphasis upon speed in the case of baemorrhage. He admitted that the wound was in a very peculiar position, and he, himself might have besitated before knowing exactly how to deal with it, but it was something they might be called upon to deal with in real life any day. The comfort of the patient, also, was very important, and must not be overlooked. In some cases the patient might have been covered with a blanket more quickly. It is half the battle if the patient is comfortable. Care must be taken, also, to use bandages for the purpose for which they were intended. Some had been used that day for purposes for which tbey were NOT intended. He concluded by thanking the patients and all who had helped to make his task easier. Dr. Gilks opened by saying that it was !hree years since he had been privileged to Judge that competition, and he was very mu.ch impressed by the improvement whIch he had noted had taken place in that time. Drawing attention to the similarity in tbe settings~Df the two Dual Tests which

he had judged, he pointed out that both patients were conscious. There were advantages to the first aider in a conscious patient, as he would be able to furnish much valuable information, but he had to be questioned. He stressed the importance of making full use of the conscious patient. At the same time he realised that this was ~ot always easy ~n t~e heat of a competitIOn, but exammatlOn of the marking sbeets would disclose that those who had gained the highest marks were those who had made use of the conscious patient. They should, also, make full use of bystanders. True, there was only one, but some teams made better use of her than otbers. When giving instructions to bystanders, they should make certain that the instructions are clear, and that the bystanders have quite understood . He, also, thanked all those who had helped him. At this stage the results were announced:

orth Thames Gas Board .. . (winning the Challenge Trophy) 2. Scottish Gas Board . .. . .. 3. East Midlands Gas Board 4. South Eastern Gas Board 5. West Midlands Gas Board 6. North Eastern Gas Board 7. orthern Gas Board ... 8. orth Western Gas Board 9. Eastern Gas Board 10. Southern Gas Board 11. Wales Gas Board ... [2. South Western Gas Board

322t

300 273 252

247 243 241 t

235

233~ 230~

228i 222-

Responding to the invitation from the chair, Sir Harold Smith said that it was both a pleasure and an honour to bave been asked to present the trophies on this occasion. He reminded his hearers that the first National Gas Competition was held in 1951, and he noted with pleasure the increasing interest which had been taken in it every year. He was pleased to note that every gas board was represented there that day, a fact to be proud of. The interest in first aid by the Gas Industry was to be seen in the large number of chairmen and deputy chairmen of Area Boards present. This event, he said, marked the culmination of a year of hard work and he reminded his audience that it ~as all voluntary-no question of payments or overtime-and it was all done with the object of being able to help one's fellow creatures. He concluded by thanking Mr. Parshall and the St. John Ambulance Association for making these competitions possible. Mr. Par.shall, on behalf of all present, thanked SIr Harold for having so readi ly accepted their invitation to present the trophies. 'We all,' be said, 'appreciate the work which he ha carried out in the Gas Industry. ' As reported in our last issue the winners of this event (The North Thames Gas B oard) came ninth in tbe Grand Prior's Trophies competitions.

The winning teams-ladies first!

T HE name ?f . I:Iarwe~ , is associated in the publJc mmd WIth one tbing, and one thlDg only, viz., the production of atomic energy, and few would consider the possibility of its having any connection with the saving of life. There are how ever, a l~rge nurr:ber of those employed by the U~l1ted Kingdom Atomic Energy Authoflty who take a keen interest in the ambulance movement, and in the final competitions for the Challenge Trophies presented by the St. John Ambulance Association and the U.K. Atomic Energy Authority, which were held at the Harwell Atomic Energy Research Establishment no less than eight teams took part. Thes~ were the winners of the preliminary trials which had previously been beld. In the team test, set and judged by Dr. J. C. Dilley, of Reading, the members arri:,e to find a workman lying on the fioor , havmg fallen from a chair which he had placed on the table in order to reach an electric light globe . Injuries: Simple fracture of right clavicle, compound fracture of right forearm (mid-shaft) with bone protruding and rather severe haemorrhage, simple fracture of left patella, nerve shock. Th~re were two dual practical tests, set and Judged by Dr. H. R. Wynne, of Banbury. os. 1 and 3 are called to a man who has slipped, knocking his left side on the rungs of a ladder and breaking an electric light bulb which he was carrying in his hand. Injuries: Wound in palm of left hand, simple fracture of 7th and 8th left ribs. Nos. 2 and 4 are requested to give assistance to a man who, whilst carrying a pair of steps, has fallen heavily to the ground. . Injuries: Slight concussion , fracture of lower jaw, left side, sprained right ankle. At the presentation ceremony the chair was taken by Mr. H. J. Grant, Head of R eactor Division, who was supported by Mr. Horace F. Parshall, T. D ., M .A.(Oxon), Director-General of the St. John Ambulance Association, Lady Cockcroft and the judges. In his opening remarks Mr. Grant thanked Mr. P arshall and the St. John Ambulance Association, and especially Mr. George Craft, the Association' wellknown competition secretary, for the valuable a sistance they had rendered in the organisation of the competition . He felt, also, that their thank were due to the

judges for the part they had played in the day's proceedings, as well as to Mr. Gale, of Harwell. Last, but not least he ~eferred to the judges, whose skill' and Judgment had contributed so much to the success of the event. The results were announced by Mr. Craft: MEr\ 1. Wind scale Works ... . .. (winning the Challenge Trophy) 2. Harwell 'A' ... ... ... 3. Harwell ' B' ... .. 4. Aldermaston Civn Defence 'A' 5. Aldermaston Civil Defence 'B'

313k 277 216 214~

182t

WOMEN 1. Aldermaston Civil Defence 'A'. .. 226! (winning the Challenge Trophy) 2. Harwell ... ... ... ... 213 3. Aldermaston Civil Defence 'B'... 166 In his comments upon the dual practical tests Dr. Wynne admitted that it had been a hectic day. He said that nearly all tbe teams had gone adrift by failing to apply indirect pressure, pointing out that the glass was lying on top of the wound. There was, also, a risk of further casualties from the broken glass which was left on the

ground. In the case of the second patient the members should have borne in mind I hat he could not peak a he wa suffering rrom concussion. . Dr. Dilley commented upon the ract that In ~he competition they had seen both beglDners and experienced first aiders, but he had to congratulate the beginners upon the manner in which they were seen to get 0!1 to . t~e case.. . Make sure of your dIagnOSIS, he adVIsed, and pointed out tbat when haemorrhage is seen it is a pointer to the di~gnosis .. The .teams had shown very great Interest In theIr work, but they must try to re~ember that tbey are treating a human being, and not just his injuries. , The patient,' he said, . has never seen you before , and you have to gain his confidence.' The fractured clavicle had been treated very well, but they m.ust ~ot be afraid of putting plenty of paddIng tn tbe arm-pit. Altogether the work had been very good. The chairman then invited Mr. Parshall to present the tr.ophies., but before doing so he address~d hIS aud.Ience, and especially the competItors. ThIS was the third year ~ha~ he had been honoured by being lOvlted to make the presentation, and he had followed the competitions from tbeir beginning. He had noted v. ith pleasure the enthusiasm and efficiency of the competitors, and if ever it were to be his misfortune to meet with an accident he would feel quite safe in the hands of thbse he had seen competing that day. He was quite certain that their object was not merely the struggle for the trophies, but a genuine desire to be able to help thei r fellowcreatures who may be in distress. Competition work was one of the best means of raising tbe standard of first aid generally. After Mr. Parshall had presented the tropbies the chairman invited Lady Cockcroft to present the first aid certificates which had been won by candidates during the year. In thanking Mr. Parsball and Lady Cockcroft for their presence there that day he admitted that he had not previously known a great deal about tbe St. John Ambulance Association but he had now learned much about the organisation and of the valuable part in it played by Mr. Parshall.

Sussex Open This was the fifth Annual Competition organised by the Sussex Open First Aid Competition Association, and was open to all first aid teams in the county. This time it was the turn of Have to act as host, and the 26 teams competing were watched by a most enthusia tic audience. In the team test, which was set and judged by Dr. H. S. Taylor-Young, of Salisbury, the member are on a motor tour, and their car is following a motorbus, from which two passengers are seen to alight. One of them slips on a banana skin and falls to the ground. Injuries: Severe wound on right hip , caused by a medicine bottle which bas broken in his pocket, fractures of right forearm, right scapula and left tibia, concussion. Dual practical tests. set and judged by

Drs. A. M. Pollock. of Tunbridge Wells. and H. A. Tuck, of Shoreham: Nos. 1 and 3 are called to see a friend who bas been injured in a football match. They find that he is well in himself, but his right knee is bruised and swollen above the kneecap, and he has a lump in his left groin. Nos. 2 and 4 are called to a neighbour whom they find curled up on his side on the bed, face half-buried in the pillow. He is comatose, cyanosed and breathing feebly and irregularly. his breath smelling of whisky, On the table are an empty whisky bottle and a box containing one blue capsule. Jt is labelled' One to be taken at night.' The presentation ceremony was presided over by R . Breffit, Esq., Chief Constable for the County of Sussex, who was sup-

FIRST AID &

8 ported by the Mayor and Mayoress of Hove and the judges. Commenting upon the team test, Dr. Taylor-Young was brief, but made some very good points. He urged them to ~ake as much use of bystanders as possLble . ever send a good first aider on a message if a bystander can be found instead. Concussion he reminded his hearers, may result f~om other causes beside a blow on the head. Few of the competitors sought the cause of the wound on the thigh, otherwise they would have found the glass bottle in the pocket, and this would have led to the discovery of the note with the doctor's 'phone number on it. Small details like this often prove of the greatest importance. He thanked the stewards who had helped him, and also the patientwho always groaned at the right time. Dr. Pollock, who spoke also for Dr. Tuck, who had had to leave early, emphasized the point that it must not be assumed that every patient MUST go to hospital. Here they had a patient suffering. from two minor injuries. In performing artificial respiration careful watch must be kept in order to note when the patient commences to breathe naturaUy. Artificial respiration, he continued, cannot be performed on a spring mattress, but examine the spine for possible fracture before dumping the patient on the flooT. At this point the results were announced: I. Eastboume Police (winning the Duke of Norfolk Bowl, awarded to the team gaining the highest marks) 2. St. John Ambulance Brigade, Hastings (Milton Di vision) (winning the Van Dyck Cup, awarded to the team gaining the second highest marks) 3. British Ra ilways, Brighton (winning the Puckert Cup, awarded to the team gaining the highest marks in the team test, excluding the first and second teams) 4. Brighton Police (A) (winning the Sussex Mayors' Association Cup, awarded to the team gaining highest marks in the Dual Tests, excluding the winners of the orfolk, Dyck and Puckert Trophies) 5. East Sussex Police 6. St. John Ambulance Brigade, Horsham 7. West Sussex Police 8. British Railways, Lancing (2) 9. Hastings Police ... 10. St. John Ambulance Brigade, Worthing 11. Brighton Power Station (B) ... ... ... t' d ] 1. St. John Ambulance ( Ie Brigade, Eastboume ... I 13. British Railways, Lancing (1) ... 14. Brighton Power Station (A) 15. South Eastern Electricity Board Eastbourne 16. British Railways, Arundel ] 7. St. John Ambulance Brigade, Crawley ... 18. St. John Ambulance Brigade, Hastings 19. Brighton Police (B) 20. South Eastern Electricity Board , Hastings

312

309

305

299

292

281 276~

27J ,! 271269t 269 268 260 259 239 226 224 223~

222

21. British Red Cross Society, Crowborough (A) . .. 22. St. John Ambulance Brigade, Lewes

2134 199

Before asking the Mayoress to present the trophies, the chairman expressed the grateful thanks of all to the stewards, the patients and all who had helped in any way to make the event the success it had proved to be, but he felt that special mention should be made of the judges, without whose co-operation these competitions would not be possible.

URSI

G, JA

UARY FEBRUARY 1957

After presenting the trophies the Mayoress was presented ",ith a beautiful bouquet by charming little Susan Venables. A word of appreciation to Mrs. Chase, a member of the Casualties Union, for the manner in which she briefed, at a moment's notice, a number of inexperienced 'patients' who had volunteered to play the parts . They acted their parts well. The arrangements for the competition were most successfully carried out by the competition secretary, Supt. icholson, of the East Sussex Constabulary, Hove.

G.P.O. National First Aid Competitions If the number of teams entered for the G.P.O. Finals, held at the Porchester Halls, Bayswater, is to be accepted as an index to the interest of the Post Office staff's in first aid, then this interest must be enormous, for 28 teams competed from all over the United Kingdom for the trophies presented by the St. John Ambulance Association, under whose auspices the Competitions were held. There were teams from England, Scotland, orthern Ireland and Wales (we hope that we have placed these in their right order !). Each team carried out a team test, after which the team of four was divided into two sections, each of which submitted to a dual practical test. All the tests contained interesting points, and are detailed here for the information of our readers. MEl'\ Team Test, set and judged by Dr. Gordon Gilles, of Burton-on-Trent: From their office window the members of the team see a man, lighting a cigarette, flung from the tail-board of a van. A leaking petrol can is near. Injuries: Wound of left temple and lobe of left ear, with concussion, compound fracture of left forearm, fracture of left patella. Dual Practical Tests, set and judged by Dr. J. A. Hanraty, of Dea l : os. 1 and 2 see a man walk out of a front door, slip and fall to the ground. Injuries: Simple fractures of 7th and 8th ribs on left side, sprained right ankle joint, shock. os. 3 and 4 are called to attend to a man who has fallen from a ladder leaning against a telegraph pole. Injuries: Concussion, compound fractures of right tibia and fibula. WOMEN Team Test, set and judged by Dr. W . L. M. Bigby , of Southampton: A man, standing on a ladder which is being held in position by his son, cuts a 'live' wire with his pliers, falls to the groLlnd, still in contact with the 'Jive' wire. The ladder falls, knocking down the boy and falling across his left leg . The team is called to help. rnjuries: Man: Asphyxia (electric shock) burns on right hand . Boy: Compound fractures of left tibia and fibula,

Dual Practical Teste;, set and judged by Dr. R . Renwick, of Watford: os. 1 and 2 are called to attend a man who was opening a bottle, when the neck broke, and the jagged pieces of glass entered his forearm. He had fallen to the ground. Injuries: Wound of right forearm, suspected fracture of left femur, shock. as. 3 and 4 are called to attend a girl who has suddenly fallen to the floor. Injuries: Apoplexy, simple fracture of right clavicle. Major A. e. White Knox, O .B.E. , M.e.. M .B., Ch.B. (Principal Medical Officel~ S.J.A.A.) occupied the chair at the presentation ceremony, and was supported by Mr. S. Sargent, e.B. (Deputy DirectorGeneral of the Post Office) and the judges. Of the many well-known personages present we noted Hon. Mrs. Leslie Gamage (County Superintendent, S.J.A.B., Berkshire), Lt.-Col. J. E. F. Gueritz, M .A. (Oxon.) (Secretary, S.J.A.A.), Area Superintendent A. H. Matthews, SJ.A.B., from Trinidad, West Indies, and others. Opening the proceedings, Major White Knox explained that he was deputising for Mr. Horace F. Parshall, T.D., M .A. (Oxon.), Director-General of the St. John Ambulance Association, whose absence he had been asked to apologise for. In welcoming Mr. Sargent, he said that it was most encouraging to have him there, for his presence did much to stimulate the enthusiasm of his teams. There were many that he would like to thank, on behalf of the Association, and he regretted that he could not possibly name them all, but one or two were particularly deserving of mention. The Associated British Picture Corporation Ltd., had helped them for many years by supplying and erecting the magnificent scenery which contributed so much to the realism of the tests. The make-up artists and 'pat ients', all trained by St. John, were a lways ready to play their most important role, and the stewards, timekeepers and many others were helpers whose services were very much appreciated. He had , ho weve r, a special word for the judges, those medical men and women who were always so ready to sacrifice their time and skill in judging these competitions, and upon whom the cQmpetitors relied so much for their training. Their well-known competition secretary, Mr. George Craft, always refrained from putting his own name on the programmes, but his valuable work was known and appreciated by all (applause).

FJRST AID &

URSr G, JA UARY/FEBRUARY 1957

9 The chairman then invited Dr. Gilles to comment upon the men'S team test which he had judged that day. Dr. Gilles commenced by saying that it was unfair to be too critical, for all the teams must have proved themselves efficient to have reached the Final. He complimented them upon the manner in which they had laid out their bandages, but in some cases the bandages had not been tight enough, and Dr. Hanraty had expressed himself entirely in agreement with this criticism. Whilst some had been too slow, some had been too fast, with the result that they had missed things. They must remember that the patient should be examined where he lies, and before his position is altered, otherwlse further damage may result. Dr. Bigby, who had judged the women's team test, said that the lack of equipment had been deliberate, as he had wanted to see them work with a minimum of material. A small number of teams had been good on artificial respiration, but he was not satisfied with many of the others, especially in the H. . method. He reminded them that they might have to keep it up for an hour or more. In some cases the examination had not been complete, and, therefore, the diagnosis had been incomplete. The results were then announced by Mr. Craft: MET': 1. London Telecommunications, orth Area, T.M.O. (winning the Championship Trophy) 2. orthern Irel a nd , Belfast Tel. Area (winning the Runners-up Trophy) 3. Midland: Birm ingham P.O.A.C. 4. London Postal: West Central

335}

319i 310}

D .O .

3091 orth Western: Manchester H.P.O .... 305~ 6. Savings : Blythe Road 1 S.B.D .... ... ... tied 303i 6. South Western: Weymouth H . P.O. ... ... J 8. Headquarters: Group 'A' H.Q. o. I Branch P.O .A.e. 291 9. Headquarters: Group 'C: Engineer-in-Chief's London Test Section ... 290 10. Headquarters: Group ' B': Supplies Dept. , Edinburgh 283,\ 11. Scotland: Perth P.O.A.C . 2811 12. Home Counties: Reigate and Redhill H .P .O. 277~ 13. North Eastern: YorkH.P.O . 261~ 14. Wales and Border Counties Swansea P.O.A.e. 240 5.

WOMEN 1. London Telecommunications: North Area T.M .O. . .. 332 (winning the Championship Trophy) 2. Headquarters: Group 'A': H .Q. No. I Branch P.O.A.e. 293 (winning the Runners-up Trophy) 3. Savings: Morecambe S.e.D. 288 4. orthern Ireland: Belfast Tel. Exchange ... 269 5. North Eastern: York H.P.O. 267t 6. Wales and Border Counties : CardiffP.O.A.e. 267 7. Midland; Birmingham P.O.A.C. 254

8. Headquarters: G rou p . B': Su pplies Dept., Edinburgh ... 9. South Western : Weymouth H .P.O .. 10. Headquarters: Group 'C': Engineer-in-Chief's Office (City) 11. Scotland: Dundee P .O.A .e. ... 12. North Western: Manchester Tel. Area 13. Factories : Birmingham Depot ]4. Home Counties: Ipswich H.P.O.

246 245 244J 240 239 233 214

Winners of the Best Pairs Trophies: Men: os. I and 2 of London Telecommunications: orth Area T.M.O. and 3 and 4 of Midland: Birmingham P.O.A.e. "Yomen: os. 1 and 2 of London Telecommunications: orth Area T.M.O. and os. 3 and 4 of London Telecommunications: orth Area T.M.O. In presenting the trophies to the successful winners Mr. Sargent expressed the pleasure he had experienced in being there that day, for he regarded the invitation as a privilege. He wished to take the

opportunity of thanking Mr. Parshall and the St. John Ambulance A ociation for "hat they \\ere doing for the ambulance 1l10\ement, and he had a special \\ord of appreciati<?n for the judges. Thi. he said. was th~ eighth Annual Competition, bur he remlllded them that the historv of first aid in the Post Office goes back 5-+ years. He was pleased to say that the movement was growing, both In numerical strength and in efficiency . Last year over -+.000 awards were made to successful first aiders and \>,.hen he heard that during the sam~ year there had been more than one million ministrations to patients he was astounded. They should be proud of the fact that it was all voluntary work. with no reward but the satisfaction of knowing that they had helped a fellow-creature. Major \\,~i~e Knox thanked Mr. Sargent for hiS lllspmng word, and for so kindly coming there that day to present the trophies. The arrangements had again been in the hand of Mr. George Craft, the S.J.A.A. Competition Secretary.

Port Authorities National First Aid Competitions In 1955 the Dock and Harbour Authorities Association instituted a Port Authorities ational First Aid Competition with the object of encouraging the study of first aid by the employees of the Port Authorities . The first competition was held in ovember 1955, when the Trophy was won by the British Transport Commission, Southampton o. 1 team. The one reported here, therefore, was the second Annual Competition, and was organised in conjunction with the St. John Ambulance Association. for the First Aid Challenge Trophy presented by the Dock and Harbour Authorities Association. It was held at the Porchester Halls, Bayswater. The ten teams which competed in the Final were the winners in the Reg ional Competitions which had been held during the previous few months, each team consisting, as usual, of four members. The tests were as follow : Team Test. set and judged by Dr. J. C. Graham, of London: Two men were stacking barrels when one slipped and fell on to the other man who fell to the ground, and was found lying on his right side. The team were called to assist. Injuries: Simple fracture of right cla\ icle, Colles' fracture (right), compound fracture of left tibia , nerve shock. The patient was conscious. Dual Practical Tests, set and judged by Dr. Lancelot K. Wills, of London. Nos. 1 and 2 are called to render as i tance to an electrician who has touched a 'live' wire \\ ith his screwdriver, which he is still holding in his hand . . Injuries: Asphyxia (electricity). burn of left hand. os. 3 and 4 are called to a man who, whilst carrying a pair of teps, has tripped and fallen heavily LO the ground. Injuries: Bruise on forehead, \\ ith concussion, dislocated right shoulder, prained right ankle joint.

At the presentation ceremony the chair

wa~ occupied by. ~r. . H. J. S. Young,

chaLrman of the First Aid Sub-Committee, "'ho extended. on behalf of all present, a cordial welcome to Mr. Francis H. Cave, the General Manager and Secretary, Mersey Docks and Harbour Board. and Chairman of the Executive Committee of the Association. ",ho had kindly co nented to present the Trophy. Before the presentation the judges \\ere im ited to comment upon the work the} had seen that da) during the tests. and Dr. Graham opened the ball. He commenced by asking: . Have you imprO\ed your work during the past year? . and referred to the individual comments he had made to each team at the conclusion of their tests. The test itself, he said, had been a traightfor",ard one, and hould ha\e been easy to diagnose, although they had to confirm the statements made by the patient. This \vas the kind of work anyone reaching a national final hould be able to do. He then dealt \\ ith two or three detailed points- bandages, knot and transport. pointing out the importance of this routine drill. They should tr) LO understand thoroughly what they were trying to do. In the case of fractured clayicle the object of treatment was to prevent further damage and complications. I n stretcher drill no single team had tested the stretcher in the proper manner. They must be more careful in handling dressings. for sterile dressings were most important in preventing further contamination, adding that one of the greatest causes of lost time in industry is infection. (Dr. Graham is MeJical Officer to a large, \vell-known industrial concern). Today, he told h is hearers, there are 185,000 accidents per annum in industry. and most of the e a re preventable. . You can do something about it,' he said. Whenever they were called to deal \\ ith an accident they hould a-k, . Ho\\ did it happen? How could it have been pre\ented?' He v, as followed by Dr. Wills who, after

FIRST AID & NURSING, JANUARY/FEBRUARY 1957

10 expressing his pleasure in judging the co!Dpetitions that day, said that he agreed with Dr. Graham in that certain essentials should receive far more attention. Gentleness and reassurance were most important factors in overcoming shock. He was sorry to note that in the competitions that day roughness had rather outweighed gentleness. Very often the upper limb and back were not examined before the patient was turned over. This could result in serious consequences. They should not omit to loosen the collar and tie and any other constrictions. The position in A.R. was not always correct, and too much pressure is often applied. (We have frequently noted, with approval, that Dr. Wills is very keen on artificial respiration.) Only one team had used the combined Schafer and H-N. system, but even they had not applied it correctly. The motion MUST be rhythmic. He had noted that more than one team had not exercised sufficient care of the head in turning the patient. In the case of the bruise on the forehead, one competitor applied the cold compress to the wrong side in his excitement! Another competitor pressed his knees into the patient's ribs whilst leaning over him. Hot water bottles had been placed in all sorts of positions. Examination of the patient must be more thorough, and dressings must be applied with greater care. In one or two cases he had seen unnecessary fussing over reefknots, ' but,' he added, 'it's my job to find fault.' Despite his criticism of details, on the whole, he said, the work had been good. The chairman thanked Dr. Graham and Dr. Wills for their very constructive criticisms, and for having spared their valuable time to judge the competitions. He felt quite certain that the competitors would have learned a great deal from what the judges had told them. He also expressed the thanks of all to the stewards, the St. John-trained 'fakers' (make-up artists) and 'patients', the time-keepers, and all who had helped to make the event a success, especially Mr. McLaughton and his staff. Mr. George Craft, the S.J.A.A. Competition Secretary, deserved their heartfelt thanks. At this stage the results were announced:

1. B.T.C. , Fleetwood ... (winning the Challenge Trophy) 2. Port of London Authority (1) 3. B.T.C., Cardiff ... 4 . B.T.C., Soutbampton (1) 5. Port of London Authority (2) 6. B.T.C., Hull (2) 7. B.T.C., Southampton (2) 8. B.T.C., Hull (1) 9. B.T.C., Garston 10. Port of Bristol Authority

lance Association, Mr. Parshall, and the Deputy Director-General, Lt.-Col. Croft, both of whom would liked to have been pre ent had it been possible. The DirectorGeneral had asked him to convey the thanks of himself and the Association to the Dock and Harbour Authorities Assoc-

iation for the splendid work they were doing for the movement. Mr. Glass thanked Mr. Cave and the Association. In replying, Mr. Cave said that the Port Authorities are realising more and more the importance of efficient first aid in the docks.

* First-Aider~s Crossword No. 26 Compiled by W. A. Potter

329 326t 321 317 314t

274 270 256 253 250

The chairman then called upon Mr. Cave, wbo, before presenting the Trophy, apologised for the fact that he had not been able to see the competitions, which he deeply regretted. 'I am the second string,' he explained, and was deputising for Mr. Elliott, who was unavoidably absent. After Mr. Cave had made the presentation Mr. Craft said that he had been asked to convey the apologies of both the Director-General of the St. John Arnbu-

ACROSS Condition found in ' fat females of forty' (10) 6. There is often alack as well (4) 10. Urge to do mischief (3, 2) II. Relative ends in skin infection (test urine for sugar) ... (9) 12. Rash first appears on forehead and behind ears (7) 13. Time of first symptoms (5) 15. Scarlet sign in lymphangitis (6) 17. Semi-finalists.. . (4, 4) 20. Where a record of one's patients may be kept ... (4, 4) 21. Roman physician a lead ore (6) 23. Heavenly old gold coin .. (5) 25. May prevent disease carried by 19 ... (7) 28. Pulls the head backwards ... (9) 29. The trained first-aider is never in these (5) 30. Polite antonym (4) 31. Fracture requiring especially careful handling (10) 1.

DOWN 1. 2.

The matter that really matters (4) Joint supporters mingle with A.T.S . (9) 3. Laxative for Anne's return (5) 4. Secretive (6) 5. Area in us of eastern and western blood (8) (5) 7. Scale may improvise bandage 8. Two foodstuffs for the pancreas (10) 9. For shock ... and gossip ... (3,2,3) 14. Great and small of the femur... (10) 16. Encourage throw back in German town (8) (9) 18. Finical about detail (8) 19. Malaria vector... 22. Supple doctor turns up at last (6) 24. Fire, railway, or shin ... (5) 26. So may many true words be spoken (2, 3) 27. Short American editor employed (4)

F1RST Am &

URSr

G, JA

UARY /FEBRUARY 1957 11

• From a seat In the audience Some Random (and Provocative) Comments on the Competitions Gas Industry Atomic Energy Come! come!! Make up your min d Padding under ankle (fractured patella) how you ,intend to blanket that stretcher. should be more solid. . CIa viele bandaging !hat bIg square case was entirely unwas absolutely useless m that position. SUItable for support under the knees Few seem to appreciate the significance (hernia). of the breathing in suspected fracture of Don't you know that a conscious patient Tlbs. can answer questions? . Don't forget that a fractured mandible is .' ~its of w?od' is not sufficiently desIDvariably compound. cnptlve of splints to a layman. She might The barrel-bandage baffled many. have brought logs or matches. .There was far too much equipment 'We':e first-aiders.' This is becoming lymg about on the floor. pafrot-Ilke. It should be more convincing. , Snap' diagnosis is creeping back aoain I.s there a house near?' He was just You won't find a pulse half-way u; th~ outSIde the front door. forearm. Once again we must emphasize that in What is ' arterial breathing'? hernia the groaning should be continuous. If the table's in the way, move it. Many of those in the audience were ot all secured the upturned chair to the moved to tears by the pathetic love scene stretcher. on the sofa. The following delicate The ma~dible must be supported AT quotation from the dialogue was obtained o CE whilst the bandage is being prethrough our Secret Agenl We therefore pared. ask o~r r~aders to ~reat it as strictly conStretcher party must OT be in step fidentIaJ: If my wlfe could see me now Pushing broken gJass from one plac~ to there'd be the very devil to pay.' another is not' removing cause.' They forgot, that, as the ' phone was There are still too many gestures. , three minutes down the road,' she would Don't let them get away with it. judges. be away at least ten minutes. Would every housewife know what a Sussex Open cold compress is, much less be able to Did he reaUy expect to find a bowl m prepare one? one 0 f t he sma II drawers 0 f the chest? . I'm examining the eye.' We didn· t Why do competitors remove jackets notice it. upon entry? This is becoming a common ~e tasted the tea before offering it to the habit. patIent. Was this quite hygienic? The inexperienced 'patients' did well How many households could provide at under the direction of Mrs. Chase. a moment's notice a completely fitted Why give detailed instructions (fractured first-aid box? clavicle) . Surely the other members knew Judges must remember that these are their work. competitions, not examinations . Was it necessary to expose part of the One team. r~moved the 'cause' (plank)body for so long? then placed It m a more dangerous position Don't use technical terms in questioning still! your patient. He doesn·t understand Place your stretcher in position before them. lifting patient. . Are you alright?' becomes irritating . 'Is the patient breathing?' He had wben constantly repeated. Just been answering questions. You can't perform .R . and ask the A spot of antiseptic cream in the centre judge questions at the same time. of the palm will not sterilise the whole Fractures are frequently credited with an hand. importance out of all proportion to otber One competitor walked on with his hands injuries. in his trousers pockets. Oh! that tiny piece of cotton wool as 'I am comparing with the other side.' adequate padding between the legs! The other side was concealed beneath the , Shift our car.' Only one team thought patient. of this. Prepared a cold compre s before the case How seldom we see the' written message.' had been diagnosed. How did he know Don't add verbal bits and pieces to your that one would be required? Incidents like written message . this lead one to wonder if leakages have Was it necessary to improvise when a taken place. full F.A. kit had been provided? , There's no traffic on this road.' Don't Congratulations to the Hastings police jump to conclusions. leader upon his knowledge of anatomy. Manipulation of patient. 'Rock 'n' 'Are we obstructing vehicular traffic? . Roll' wasn't in it. They were on the pavement. 'Have you got any splints?' Did he Padding a splint i not a formality, but a really think that a bystander would be necessity. walking about with a pocketful of them? . I'll get you a cup of tea,' but where was , You can't have hot-water bottles until it corning from ? They were mile out in the kettle boils.' the country. Is the use of the rolJer bandage first aid? Don't collect a lot of material you have He moved the ladders, certainly-but no use for--car seats, for instance! blocked up the doorway with them. Make up your mind, Skipper, whom you G.P.O. really want 'phoned. We don't like to listen to a continuous Where should the knot be tied-in the recitation from the leader-and neither middle of the sole or at the side? doe the judge,

What a long time they were disco\'ering that fractured patella. · If strips were not long enough, why not tIe two together? How on earth can a judge listen to three or ~o~r talking at once?-and it ,\asn't a ladles team, either! ~or goodness sake do learn the correct pOSILlons of the various ribs. Documentation \\ as overlooked in more than one case. Surely a better support (patella) could have been found than that box with its sharp edges. · Do try to realise the value of 'history' in dIagnOSIS. ~e were pleased to see less orthodox eqll1l?me.nr provided, thus stimulating improvls.atlor:. However, more yet can be done III thIS respect. That sling must have nearly strangled her. We .hope the P.M.G. bought them four new tIes. Ambulance AND doctor are not necessary. , Any shortening?' Where's your tape measure? One ladies' team appeared to treat the whole thing as a joke. Took their nylon stockings off to use as bandages. Again we "Ould draw the attention of the P.M.G. . Detai.1 ed . instructions for 'promoting clicula.tJOn should have been given. The barmaId was not a first aider. ow, o. 2, don·t stand there like a dummy. Do something. Supine - prone - supine - prone _ make up your mind . · I'm supporting his Jeg.' It wasn't very noticeable. Tuck those ends in, madam . J

Dock and Harbour Authority There is a tendency to discontinue A.R . too oon. Some competitors expect the bystanders and ste\:\,ards to do the job for them. Still too much time spent on the telephone. How awkwardly many competitor set about rolling a blanket. Ask your .0. to teach you how to change an undersheet. Do try to appreciate the value of observation of face and T.P.R. Only with the help of the patient could he possibly have turned him by the shoulders alone. Patients, please don't help. W~at peculiar methods of testing pupil reactlOn are adopted by some competitors. , Where's the telephone?' Had it been alive it would have bitten him. Judges are becoming less and less impressed by the voluble leader. Significance of a bruise on the forehead is not always fully appreciated. ever mind what his reaction would have been if consciou. He was not con ciou . 'Is there any cold water avaiJable?' He was on the quayside. about? . ny qualified first-aider How many more did he want'? There were four in the team.

FIRST A1D & NURSING, JANUARY/FEBRUARY 1957

Beader~

queries Answered by Dr. A. D. Belilios

P. J. D. (Sheffield) writes:A friend of mine has had a lot of trouble JIIith a condition of the nose which he has cal1ed an antrum. J wonder (f Dr. Belilios would kindly explain something about this disease. Answer One of the largest bones of the face is hollow and its cavity which is lined with a mucous membrane communicates with the nose and imparts resonance to the voice. Spread of inflammation into this cavity called the antrum sets up the condition you mention. Moreover, the opening into the nose may become blocked and the antrum filled with pus. In this case, the opening may have to be unblocked or even made larger in order to liberate the fluid that has collected therein.

B. J. S. (Cardiff) writes:I have been asked to attend a children's holiday camp during the summer and acr as the first aid officer. Unfortunately, I myself am subject to epilepsy but thanks to the various drugs which my doctor gives me only rarely suffer from aftt. My conscience pricks me a little about accepting this job and f shall be very grateful for any guidance you can give me.

Answer I think you are morally obliged to 'put your cards on the table' with the organisers of the camp for you would never forgive yourself if by an unfortunate chance you had a fit when your services were needed and there was no one at hand to help. Moreover, the other officers of the camp should know how to treat you should an emergency arise,

I a III sorry but there is nothing to be ashamed about in suffering from Your question raises a epilepsy. similar problem in other spheres.

* * * * R. M . G. (Streatham) writes:Our lecturer has criticised the S.J.A.A. manual where it states on page 94 that the hands may be rendered sterile by the application of an antiseptic. This, he says, is not possible. As there seems to be two opposite opinions" a ruling through your valuable column lVould be welcomed.

Answer I am inclined to agree with your lecturer that the bands cannot be rendered actually sterile by an antiseptic although they may be nearly so. Hence the first aider must avoid touching a wound as much as possible and handle dressings by tbeir edges so that he does not contaminate the part which comes into contact with the wound and generally observe the principle of scrupu lous c1ea nIi ness referred to j n the manual.

* * * * J. L. T. (Worcester) writes:I had an interesting case recently . My next-door neighbour asked me to go in because his wife had cOI?fessed that she had eaten eight amy tal tablets. The Ivoman was Quite conscious and talkative and I found out that she had taken the tablets jive hours before. f am not quite sure what amjlfal is 01' whether I should have inciuced vomiting. [ sent for the doctor who had the patient removed to hospital. Would Dr. Belilios please give some information on this subject. Answer Amy tal is a barbiturate and when taken to excess causes coma. You do not say what variety was taken for there are several, or the dosage. If the patient was conscious five hours afterwards. the amount taken is very unlikely ' to be large . Unconsciousness would have occurred much earlier- probably within an hour- if it were going to occur at all. It was too late to induce vomiting but the doctor took the

FIRST A JD & NURS JNG, JANUARY/ FEBRUARY 1957

right action in sending the patient to hospital for observation both on the patient's physical and mental condition. ,~

D. R. (Slough) writes:I am in charge of the first aid room in a factory . Several workers have recently asked me to remove wax from their ears because they have -gone deaf I do not know quite how to do this and we haven't got a sy ringe, but I am sure the management would buy one for me. Would y ou let me know what to order and give me some idea how to undertake what is, I understand, a simple procedure.

Answer 'No, no, a thousand times no! ' This is quite beyond the scope of first aid and entirely a job for a doctor who must first examine the ear with a special instrument called an auriscope to prove the presence of wax. Besides there are other methods of removing wax other than by syringing, e.g. the use of drops, and the doctor must decide which is the best method to adopt.

* * * .,. R. B. (Silvertown E.16) writes:We are still wondering what is the correct position of the patient in cases of 'head injuries.' The Black book states in all cases of head injuries, raise the head and shoulders, but then we get the Supplement which tells us, how to treat the patient when Ive get' bubbly' breathing. Will y ou please state: In a case of concussion do we raise the head and shoulders and turn the head to one side? In compression, say, aji'actured dome, do we raise the head and shoulders? In a case of apoplexy do we raise the head and shoulders?

Answer The supplement must supercede the text. 1 presume that your questions refer to cases where the breathing is not ' bubbly' in which case in concussion I wou ld keep the patient lying flat with the head to one side; in established compression and apoplexy I would favour ra ising the head and shoulders.

Bedford The 'one-make' fleet

Lomas HB type" ambulance on Bedford A2 ambulance chassis. Prices from . . . £1,504. 2 . 6.

It pays fo standardise on

-Fire Appliances

from £1,778

,Iittii 42 Seater Buses

from £2,740

Bedford Day in, day out Bedfords brilliantly perform all the varied transport tasks of public authorities. No other range of vehicles has such a high reputation for reliability and economy. Modernly designed Bedfords form the ideal 'one-make' fleet; they pay in every way! 'Onemake' transport means greatly simplified maintenance and spare part stocking. To this add the extra Bedford advantages of low first cost,

low upkeep cost, low-priced readily available replacements, and Square Deal Service from 520 authorised Bedford dealers. With a range of chassis covering all loads from 10 cwt. to 10 tons, there is a Bedford for every local government needyou see them everywhere. Full particulars from your local Bedford dealer, or wri te direct to the Municipal Vehicle Department, Vauxhall Motors Limited, Luton, Beds.

FOR EYERY lOCAl GOVERNMENT NEED

Bedford Scammell Tractors rrolll £713 plus £151,IA rT

C rew Buses

from £529.10.0

_.,-.'Il?\ .

Tower Wagons from £1 ,1 85

F IRST AID & NU RSING, JANUA RY/FEBRUARY 1957

An Appeal THE EDITOR.

Dear Sir,

First Aid with the Army ReseYl'e

As a regular subscriber to your journal I would like very much to obtain your assistance in the following: I am the quartermaster of the 24th General Hospital Army Emergency Reserve, and we are trying to enlarge the numbers of our volunteer cadre. Although we would prefer ex R.A.M.C. men, others with similar qualifications or holders of first aid and /or nursing certi ficates could be considered, the age limit being up to 45 on joining. There is plenty of scope for promotion as we are shorl of N.C.O.s and facilities exist for upgrading in the trade groups. The only training that has to be carried out is the 15 days annual camp usually in the south of England, and in exchange pay and allowances of any rank or trade held plus a tax free bounty. For the ladies a similar scheme is in operation with the Queen Alexandra's Royal Nursing Corps. E. J. GREEN, Capt. R.A.M.C./A.E.R. 74 Waltham Way, Chingford, Lond'on , EA.

Privately Owned X-ray Unit PORD Motor Company Ltd., the D agenham (Essex) vehicle manufacturers are believed to be the first privately owned British concern t.o have their own mobile X-ray unit. Costing £7,500, the Ford mobile X-ray unit has gone into operation. Intended to visit outlying Company locations- they extend from Southampton and Croydon to Leamington and Doncaster -the un it is for the mass radiography of some 25,000 employees at regu lar intervals, This will greatly widen the scope of the medical department's X-ray section. The unit is self-contained and only needs to be connected to supplies of water and electricity. In one section of the vehicle employees will be photographed. In another part the exposed film will be processed and checked for signs of any disease or abnormality of the chest. The X-ray unit is a four-valve mass radiography one capable of photographing on 35 mm. film and, when necessary, on large radiographs. Painted cream and blue, the body is mounted on a Thames 5-ton chassis with a 45-in. Baico extension. The vehicle is powered by a Thames 4-D diesel engine. Bodywork is by Pilchers of Kingston. who also fitted it to the chassis. The vehicle is 27 ft. 8 in. long.

'Ampins' The 'Ampin' emergency tjn has been designed for those first aid boxes and posts where morphine or its equivalent must be always at hand. The tin is strong, clearly labelled and sealed with tape which is quickly stripped. It contains, for subcutaneous injection, six' Ampins ' of either morphine sulphate t gr. or an equivalent dose of tetrapon which is a mixture of alkaloids of opium made to Swedish Pharmacopoeal standards. Also included are six tie-on labels stating that morphine has been given, and on the inside of the lid there are clear pictorial instructions for use. Altogether, this handy pack is ideal for use in mines, aircraft and ships. Nor is there any reason why it should not be filled with I ml. subcutaneous' Ampins ' containing other drugs . The 'A.JTIpin' is recognised as an , ampoule-syringe' by the Ministry of Transport and Civil Aviation. The tins are available from Cuxson, Gerrard & Co. Ltd., Fountain Lane, Old bury, Birmingham.

Team 1. North Western Gas Board, No.1 2. West Midlands 'Gas Board 3. South Eastern Gas Board 4. North Western Gas Board, No.2 5. North Eastern Gas Board ... 6. North Western Gas Board, No . 3 7. East Midlands Gas Board 8. South Western Gas Board It will be seen that the Liverpool (North Western No, 1) team made a runaway victory io both classes. They were: Miss V. J. Spakman (Captain); Miss C. H. Price; Miss M. L. Anderson; Miss

Institute of Certified Ambulance Personnel The following were successful in t he examinations of the Institute of Certified Ambulance Personnel held on November 17th, 1956, in London. Final Edward John Baker, Bath, Somerset. Terence W. Franklin, Bath, Somerset. John Byrne McKie, Kirkconnel, Dumfriesshire. George Henry Robson, Ash ingto n, Northumberland. Marian Smith, Cradley Heath, Staffs. William R . Smith, Bath, Somerset. Mrs. Marian Smith gained top place and Mr. E. J. Baker second place. Preliminary Walter J, Tanner, Northwich, Cheshire. William Fox Examination Trophy This Silver Cup which is given annually to the candidate who gains highest marks in the Final Examination has been won by Miss Elizabeth Coles, S.R.N., of Bath, Somerset. The Cup will be presented to the winner at the Annual General Meeting of the Institute, which is to be held in London on February 27th, 1957.

Ladies Enter the Gas Industry Competitions For the first time the Gas Industry entered women's teams in the National First Aid Competition organised by St. John's Ambulance Association, which was held at the Porch~ster Halls, .Lon<;lon, last year and reported ill our previOUS Issue. To pick the team to represent the industry a preliminary contest was held at Nantwich, Cheshire. Six Area Boards entered teams, the North Western being represented by three. It was one of them

FIRST AID & NURSING, JANUARYjFEnR UARY 1957

-from Liverpool- which won the first place; West Midlands was second and South Eastern third. As in the men's contest the test included one for the team and t ' ind'vid 1 t t . . wo . l ua es s for pans In the teams. The full results were:(The points are out of a maximum of 400-200 for team and 200 for individual tests). Individual Teall7 Tests Tests TOlal 155~ 179 334t 122~ 149 27H· 112 254~ 142} 106 148 254 116~" 136 252 J 80~ 154 234~ 88 143 231 115i 99 214& R. 0. Broadfoot; Miss Z. Parry (Reserve.) As reported in our last issue this team came fourth in the Grand Prior's Trophies Competitions.

'NESTOSYL' Anmsthetic-Antiseptic Preparations For the treatment of lesions or bruises of the skin and

the

orifices.

mucous

membrane

natural

the

Rapid anresthetic action due to

the advantage of an association of ethyl and butyl esters of para -amino-benzoic acid.

N on-T oxic:

NON-IRRITANT

Four forms are available :

OINTMENT OILY SOLUTION SUPPOSITORIES OVULES Attention is drawn to the Oily Solution which is of considerable

Miscellaneous Advertisements should be sent to Firsl Aid &, Nursing, 32 Finsbury Square, London, E.C.2. Rate 4d. per word, minimum 65. Box numbers 15. extra.

SCENT CARDS. 250 18/6, 1,000 52/6. Tickets, Printed Pencils, Memos. Samples free.-TICES, 11 Oaklands Grove, London, W.12. S. J. A. B. Badge Wall Shields, 26s. 6d. S. I. A. B . Gold cased crested Cuff Links, 50s. S.J.A.B. Badge Ladies' Brooches 21s. Tr?phy Shields supplied. Medal ribbons 9d. each on buckram for se~ing o~ umforms, Is . each ribbon if mounted on pin brooch. Medals mounted, miniatures quoted for. Stamp for leaflets. - Montague Jeffery, Outfitter, St. Giles Street, Northampton. CO~.PETITION

TESTS, Colliery or Non·Colliery. Team Tests 6 for 4/6d. [ndlVldual Tests, 6 for 3/-. Postage extra. Drabble 43 Ca:"bria Road Mansfield, Nolts. ' , ,

E.S.P. TRAINING MODELS

Literature available to members

help in catheterisation.

oj the Medical and allied

Is you r Unit eqUi pped with The ESP MI N IAT U RE SKEL ETO N? 26" high, scale model of the human skeleton.

professions only.

W rite now for deta ils o f t h is a nd other valuabl e trai n in g a;d s i n cl u di ng : . SCULPTURED SKELETON (FULL SIZE ) MINIATURE DISSECTIBLE TORSO MOTHERCRAFT DOLL HUMAN EYE HEART, EAR, ETC., ETC . Prompt attention to all enquiries. Illustrated brochure from

Sole Manufacturers :

EDUCATIONAL & SCIENTIFIC PLASTICS LTD. 71 Br igh t on Road , Hooley, Coulsdon , Sur rey Te l : Down la nd 2402

8 ENG U E "

CO., LTD .,

Manufacturing Chemists,

MOUNT PLEASANT-ALPERTON ·WEMBLEY· MIDDLESEX

FIRST AID & NURSlNG , JANUARY /FEBRUARY 1957

FIRST AID &: NURSING, JANUARY/FEBRUARY 1957

BRITISH RED CROSS SOCIETY

UNIFORMS

OFFICERS (MALE ) TUNIC & TROUSERS

From Government specified materials (Fine Serge-BS 1771) ... £11. 0.3 (Fi ne Serge-BS 2551) ... £ I0.1 0.5 OFFICERS (MALE) GREATCOAT

From Government specified material (Waterproofed melton BS/I77I) ... £7. 4.1

for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society call be obtained from

MITCHELL HOUSE,

From Government specified materials (Rough serge) £4. 0.7 (Fine serge) ... ... £4.16.2

228,

OLD STREET,

LONDON,

E.C.I

CLErkenwell 9274/5

TROUSERS

DOBSON & SONS (London)

£1.17.4 £2. 9.1

PATTfRNS

GREATCOAT

(Heavy melton cloth)

UNIFORMS and LADIES~ GREAT ~OATS & ~OSTUMES

BARNETT MITCHELL LTD.

MEMBER (MALE) TUNIC

(Rough serge) (Fine serge) .. ,

MEN~S

... £6. 6.10

AND

PRICE.

LIST

CAN Bf SUPPLlfD ON APPLICATION

PURCHASE TAX TO BE ADDED TO ABOVE PRICES

UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS 154 - 164 TOOLEY STREET LONDON BRIDGE S.E.1 'Phone:

Nineteenth Edition. Completely revised. 261st thousand. 286 pp., 286 illustrations, some coloured, 65. 6d., post 4d . WARWICK AND TUNSTALL'S

FIRST

AID

TO THE INJURED AND SICK Edited by A. P. GORHAM, M.B., Ch.B., M.R.C.S.

Police Surgeon . City and County of Bristol

'FIRST AID' WALL DIAGRAMS 26 X 40 in.

Hop 2476 (4 lines)

'Grams,'

"Hobson, Sedist, London"

iheUNIT TRESTLE Patent applied for.

A light, rigid and efficient trestle providing two stretcher positions - one horizontal and one inclined.

t4fr:10DS OF ARnFlClAL RESPIRATIO~

A- G Anatomy and physiology. H-J The triangular bandage . K . L The roller bandage. M, N H;:emorrhage and wounds. 0 , P Dislocations and fractures. Q . R Transport. S, T Artificial respiration.

Single Sheets : Linen - 75 .• plus postage. Paper - 55 .• plus postage. Set of 20. on Roller: Linen - 1505., post fre e. Paper -1005., post free. The British Red Cross Society have specially adopted a set of 6 sheets , A, D, M, N, 0 , P, which can be supplied on linen with fittings for the special price of 50s. , plus postage.

JOHN WRIGHT & SONS LTD., BRISTOL

Designed to nest in transit vehicle or when stored, Rubber stops locate stretcher and provide handles.

INVALUABLE IN COMPETITION WORK

Six trestles when stacked occupy 2 10" x 2 6" floor space.

THE

HUMAN SKELETONS Articulated and Disarticulated. HALF SKELETONS, Etc., Etc.

Please write for details PLEASE PLACE ORDERS EARLY FOR MARCH 31st

G. McLOUGHLIN & CO. LTD. Dept. F.A., VICTORIA WORKS, OLDHAM RD., ROCHDALE, LANCS. Rochd;i:~977

HOUSE FOR

Waterproof First Aid Dressings are intended (or use when a wound is exposed to water, or contamination from oil. dirt etc., and where necessitated by hygienic requirements. Illustrated is Our most popular assortment of such dressings (Adaptopruf No. M207) consisting of 114 adhesive plast.ers of ~ve different sizes. Each has a dressing pad of soothing, qUick healing Euflavine, a most effective medicament equally for wounds and burns. Whenever a waterproof plaster is not essential we recommend Adaptoplast First A id Dressings be used. PIONEERS OF A PRODUCT o~ _L' _A'" ESTABLISHED 1878 INDUSTRIAL t'uX~P'H. ~E/Vlf"c:7tt1. 'Phone FIRST AI D I DlDBURY BIRM INGHAM BROadwell 1355

ADAM, ROUILL Y & CO. Human OsteOlogy, Anatomy. Etc. 18 FITZROY STREET. FITZROY SQUARE. LONDON. W.1 TELEPHONE: MUSEUM 2703

A NEW ALL-METAL 2-STRETCHE AMBULANCE ON THE LA D ROVER I 7 in. W /B CHASSIS

T AID

&: NURSING MARCH/APRIL 1957

PRICE FIVE PENCE 3/6 per Annum Pose PaId

ales louJer than

THIS up-to-date ambulance incorporates the latest aluminium alloy construct io techniques to combine toughness with comfort, and has all the mobility an tenacity afforded by a 4-wheel drive. The design provides for two stretchers and an attendant, one stretcher anj three sitting cases, or six sitting cases. Features include bUilt-in wash bas in with water supply, fully insulated bool for tropical use, and adequate locker accommodation. You are invited to apply for full details of Mobile Medical Units, Ambulances, etc., built to your particular requirements for service in any part of the world.

PILCHERS

AMBULANCE & MOBILE UNIT BUILDERS

314 Kingston Road, Wimbledon, S.W.20 Telephone: LiBerty 2350 & 7058

•

47 High Path, London, S. W .19 Telephone: LiBerty 3507

Printed by HOWARD, JONES, ROBERTS & LEETE, Ltd., .26-28 Bury Street, St. Mary Axe. London, E.C.3. and published by the Propnetors, DALE, REYNOLDS & CO., Ltd., at 32 Fmsbury Square. London. E.C.~. to whom all communications should be addressed.

SKIN INFECTIONS are primarily caused by Staphylococci, Streptococci and B . Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms.

ANTIPEOL is therefore

an essential component

for burns and scalds, ANTIPEOL OINTMENT is both non-adhesive and AS

TREATMENT

of every First Aid and Nursing Kit.

antipeol cutaneous ointment Produced by the makers of: ENTEROF AGOS for intestinal complaints; RHINO-ANTIPEOL for nasopharynx infections; OPHTHALMO-ANTIPEOL for ocular infections; DETENSYL for reducing arterial tension. MEDICO-BIOLOGICAL LABORATORIES LTD., CARGREEN RD., SOUTH NORWOOD , S.E.2S

FIRST AID & NURSING, MARCH/APRIL 1957

UNIFORMS and LADIES!' COATS &: COSTUMES

Nursing

for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

March/April 1957

HOBSON & SONS (London) UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS 154 -164 TOOLEY STREET LONDON BRIDGE · S.~.~ 'Phone: Hop 2476 (4 lines)

'Grams:

PATENT

"PORTLAND'~ AMBULANCE GEAR The Gear Illustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leaving other side clear for sitting patients. The UP AND DOWN action is quick and easy for loading or unloading. A . Shows the two stretchers in position. B. Shows the top stretcher lowered read y for loading.

C. Illustrates the same Gear w·jth the top stretcher frame hinged down for use when only one stretcher case is carried. D. Shows the same position as in I f C" only with cushions and back rest fitted for convalescent cases.

Where Ambulances are required to carry four beds two Gears are fitted, one on EITHER SIDE. and the s·ame advantages apply as described above. FuN catalogue of Am bu la nce Equipment No.7 A will be sent on requtst.

65, WIGMORE STREET, LONDON, W.I 'Phone I WELbeck 0011 (Late GREAT PORTLAND STREET)

The Future of the Team Test

St. John Regional Course

Officers' 7

From a Seat in the Audience 10 , Fakers ' and 'Faking'

Casualties Union News

First Aider's Crossword No. 27 12 Readers' Queries

unit is independent of the engine cooling and provides ample warm, fresh aIr to the ambulance compartment within two .minutes of starting from cold; and it contmues to do so even when the ambulance is stationary with the engine switched off. In summer it provides cool fresh air for ventilation. ' Basically, the chassis is the Austin L.D. series as used for the familiar 1 ton and 30 cwt. delivery vans, but suitably modified to the Council's requirements. The principal modification is the off-setting of the rear axle differential in order to provide a low floor level at the rear entrance and thereby to dispense with the need for special stretcher-loading fitments. The new ambulance is easily manoeuvrable to cope with the traffic conditions in central London; it retains all the low loading and other desirable features of the existing ambulances, but is much smaller in overall dimensions, much lighter in weight and more economical in operation. The first of the new vehicles has just been brought into service and 12 or more are expected to be in use by the end of the year. s~stem

First Aid Volunteers Wanted Urgently

Diseases oftheDigestive System

Competitions

New 'Plastic' Ambulance for London County THE ~.e.C.'s white Daimler am bulances, WhICh have been a familiar sight on London streets since the end of the war may soon give way to a new design of amb~l?-nce more su.ited to present-day condItlOns and meetmg the requirements of the L.e.C.'s Health Committee for a high standard of service to patients combined with economy in operational and maintenance costs. The L.C.e. has, over many years, built up a reputation for leadership in ambulance design. The .prototype of the Daimler ambulance was designed and built in the workshops of the L.e.e. Supplies Department at Wandsworth. Now, after two years of development work, the L.e.C. has again produced a vehicle which marks a big step forward in ambulance design. The body of the new ambulance, designed and built entirely in the Council's own workshops, is of reinforced plastic construction, combining the lightness, strength and durability needed . The accommodation for patients is comparable to that of existing ambulances, and there are improvements in details: the roof is translucent; the heating and ventilating

In this Issue

" Hobson, Sedist, London~

.·c~

First Aid

no you knOll)

that • •• The giraffe and the whale both have the same number of vertebrae, viz., 7 ? 'M. & B.' stands for May & Baker Ltd., the well-known manufacturing chemists ? In the middle of the nineteenth century Sir Henry Layard found a magnifying lens cut out of rock crystal in the ruins of Nimrod's palace at Ninevah? The instrument which the doctor uses to measure your blood-pressure is called a sphygmomanometer? Atropine, used by opticians to dilate the pupil of the eye, is obtainect from deadly nightshade and henbane ? Ambergris, used in the manufacture of perfumery, comes from the intestines of the sperm whaJe ?

THE expansion of Vauxhall Motors Ltd., at Luton, wiil mean increases in all sorts of services-not the least of which will be first aid. The medical division would, therefore, very much like to recruit a further 150 candidates and prepare them for St. John Ambulance Brigade Association examinations, so as to bring the first aid strength up to 250 or so. This is in order to ensure that there will be qualified first aid men on hand throughout the factory at all times. Already all those who helped in first aid duties during the war and those known to be connected with first aid sections or organisations have been asked if they would care to help. Classes in first aid will be arranged by the Company Medical Officer, Dr. A. R. Thompson, in conjunction with the Vauxhall S.J.A.B. Recruits will be instructed in batches of fifty. Those attending these classes will receive 3s. per hour while they are learning. Classes will be instructed by qualified

members of the St. John Ambulance Brigade. Certificates will be presented to successful entrants at a special function and those who pass the examination will be invited to register on a list of retained first aiders. While on this retained list they will receive 32s. 6d. per quarter. The rate will be increased according to qualifications to as much as 65s. per quarter. First aiders will be retained so long as they pass an annual re-examination, and fulfil certain duties as assigned by the medical officers, and industrial first aid staff. Although this programme is only concerned with recruiting industrial first aiders, it should increase interest in the St. John Ambulance Brigade, and all ranks have been cordially invited to help. First aiders who pass will be invited, of course, to join the Brigade. Volunteers are welcome to contact W. H. Hum by, Vauxhall Motors Ltd., Kimpton Road, Luton, Beds.

Forthcoming Eyents Girls' Life Brigade (inc.), London. Distillers' Company Ltd., Conway Hall, Red Lion Square. B.T.e. (Railways and Docks) and B.T.C. Police, Central Hall, Westminster. Ministry of Supply, Central Hall, Westminster. June 21st Dock Labour Board, St. Mary's College, London, E. National July 6th Casualties Union, Regional Eliminating Rounds. July 7th S.J.A.B. Finals (Dewar and Perrott), Central Hall, WestJuly 13th minster. N .H.S.R. Mobile Units Finals, Sophia Gardens Pavilion, July 20th Cardiff. September 13th National Fire Brigades, Southport. . . October 6th Casualties Union, Final Competitions, London UDlversIty Sports Ground, Motspur Park. October 23rd G.P.O., Porchester Halls, Bayswater. November 6th Dock and Harbour Authorities, Weston-super-Mare. November 14th Grand Prior's Trophy, Porchester Halls, Bayswater. . The dales for the following have yet to be fixed: United Kingdom AtomIC Energy Authority, Gas Industry and National Road Passenger Transport (London Transport). May 18th May 30th June 5th

FIRST AID & NURSING, MARCH/APRIL 1957

A Course in Elementary Medicine

Diseases of the Digestive System

IN ofoursome last article, we began a study of the commoner diseases of the digestive system; this month the description will be continued. Cancer of the Stomach Facts must be faced by those who desire to study elementary medicine, hence these articles would be useless if they failed to refer to some of the more unpleasant ailments of which this is one. The disease generally affects middle aged or elderly patients and is more common in men than in women. Usually symptoms develop comparatively quickly in a patient who has formerly had a good digestion. These symptoms can be very variable and include pain or discomfort in the' pit of the stomach' with occasional nausea and vomiting; the vomit may contain blood. There is flatulence and loss of appetite, particularly for meat. Diagnosis can be made by a number of tests. X-rays are very valuable. For this purpose the patient is given what is called a barium meal. He is made to swallow a small quantity of a mixture containing the chemical called barium which is opaque to X-rays and therefore shows clearly the outline of the stomach. If cancer is present it may show up as a deformity in the wall of the organ. It should be noted that a barium meal is used as a method of diagnosis for other stomach complaints such as an ulcer. Examination of the interior of the sto~ach can be undertaken by using an mstrument called a gastroscope which is like a telescope. Th~ apparatus, which is illuminated is passed through the mouth, down'the oesophagus and into the stomach. The treatment of cancer of the stomach is an operation and the sooner this is undertaken the better the patient's chances of complete recovery. Gastro-enteritis This is a common complaint and consists of inflammation of the

By A. David Belilios M.B., B.S. (Lond.), D.P.H. (Eng.) stomach and intestines. It has many causes, such as eating a food which is itself tainted or by taking a poison of an irritant character. Many cases are due to a germ or virus and hence are infectious. Thus it is not unusual to have several cases at the same time in a household or even an epidemic in a neighbourhood. Symptoms and signs include nausea, vomiting, colicky abdominal pain and diarrhoea. Often there is fever while occasionally blood is passed in the motions. In infants and young children the dis~ase can be particularly serious, owmg to toxaemia and loss of fluid from the body. Toxaemia means the presence of a poison (toxin) in the blood; the toxin is derived from the causative germs in the bowel. Many of these severe cases are called English dysentery and are due to a germ called the sonne bacillus. An infant so affected loses weight rapidly, its eyes become sunken and its skin loses its elasticity. Convulsions may occur or even coma. Fortunately modern medical treatment and nursing skill can nowadays save many of these babies who before the war might easily have died. Appendicitis The appendix is a small blind tube about 4 in. long that leads off from the caecum, the first part of the large iptestine which is situated on the right side of the lower abdomen. So far as is known, it is of no value to the human body but is liable to become inflamed thn;mgh germ infection causing the well known ailment of appendicitis. There are several varieties of appendicitis-acute, sub-acute and chronic, of which the first only. will be described in this article, since it is an urgent condition. .Acut~ appendicitis begins suddenly WIth pam often in the upper part of the abdomen or around the navel. This pain, which is of a dull aching character, soon alters its position and moves downwards towards the lower right side of the abdomen where it settles. '

Other characteristics Include nausea, vomiting, a furred tongue ~nd cOl?-stipation: In addition, there IS an 111crease In the rate of the pulse and the temperature of the body rises. .Examination of the appendix at thIS stage shows that it has become swollen, red and inflamed' as the disease progresses it may' become filled with pus which cannot escape. This leads to increased swelling and the appendix now appears rather like a boil which is coming to a head' it may, in fact, perforate, causing a~ abscess or even peritonitis. The object of medical treatment is to operate on the patient at the earliest possible stage and before the complications described above have had time to develop. This will generally be within 48 hours of the commencement of the complaint. If an abscess has formed, immediate operation may be undesirable and the doctor may then decide to treat the patient by rest in bed, diet and special drugs until the absces~ has dispersed when the operation can be more safely performed. This, however, involves a much longer illness and absence from work, hence the prime importance of promptly seeking medical advice in all cases of abdominal pain. Colitis As its name implies, this disease consists of inflammation of the colon. There are two main varieties, mucus and ulcerative colitis respectively. The former is associated with constipation accompanied by passing a variable quantity of mucous (slime). It is an ailment not u:r:common in the nervous types of patient, who suffer [rom dyspepsia. In the ulcerative type, ulcers develop in the mucous membrane of the colon. Symptoms include diarrhoea, the patient passing frequent n~otions containing blood, pus and slIme. Often he complains of colicky abdominal pains, loses weight and becomes anaemic. Intestinal Obstruction Any obstruction to the free passage of foodstuffs along the course of the

FIRST AID & NURSING, MARCH/APRlL 1957

intestinal tract may cause the condition known as intestinal obstruction of which the acute variety is of importance in these articles. It may result from various causes such as a growth or rupture (hernia). Sometimes it is due to a small band of fibrous material which kinks some of the intestine. The onset is normally sudden, the patient being seized with severe griping pain in his abdomen .centered at first chiefly round the navel. The pain is accompanied by a desire to have an action of the bowels, but neither wind or a motion can be passed by the rectum. Soon vomiting follows; at first the patient brings up his last meal; then the vomit becomes green in colour, since it contains bile; finally it becomes brown with a most unpleasant odour resembling a bowel action and for this reason is called faecal vomiting. The general condition of the patient deteriorates rapidly and a surgical operation must quickly be performed to deal with the cause of the obstruction. Di verticulosis This long word is used to describe a condition in which a patient develops a variable number of small pockets called diverticula in th e large intestine, particularly in the descending and pelvic colon. Some are so small that they can hardly be distinguished by the naked eye; others attain a size of i in. in diameter. Diverticulosis is very common in the middle aged and elderly and in itself causes no symptoms. But if inflammation of the diverticula takes place, the complaint known as diverticulitis occurs. It will readily be understood that if there are small pouches in the bowel, food that has not been completely digested and debris are liable to collect within them and by their stagnation set up inflammation. Symptoms are variable. Often the patient complains of indigestion and discomfort which is most marked in the lower left quandrant of his abdomen. There may be attacks of colic accompanied by a rise of temperature. Constipation, from which many of these patients have suffered for years, tends to increase. Diagnosis is made by an X-ray, the patient being given a barium

enema before the picture is taken. The barium enters the diverticula and clearly demonstrates their presence. Jaundice The liver is one of the largest glands in the body, and is situated in the upper part of the abdomen chiefly in the right side. It ha~ many functions of which, from the point of view of digestion, the secretion of bile is the most important. Bile is a thick greenishyellow fluid produced continuously by the cells of the liver to an amount of about 30 oz. per day. It is collected by numerous channels which ultimately form two mai~ ducts (larger channels) which leave the right and left lobes of the liver and join each other to form the common hepatic duct which carries the bile down to the second part of the duodenum where it enters the digestive system. An off-shoot of the common hepatic duct-called the cystic duct -leads to the gall bladder which, situated on the under surface of the liver, stores bile until it is most needed during digestion.

Jaundice- a well-known ailment -occurs when the colouring material of the bile called the pigment, enters the blood and is hence carried round the. body. For this reason, the patIent develops a yellowish colour of his skin, first showing itself in the whites of the eyes. At the same time, the urine becomes dark brown in colour rather like strong tea while the motions become pale like clay. Naturally the patient's digestion is upset, since the bile is not assisting with digestion . Complaints of nausea, vomiting and flatulence are common, while there is usually loss of weight and appetite particularly for fats. A characteristic feature is nervous depression and in the words of the poet, he ' looks at the world with a jaundiced eye.' There are many causes of jaundice; thus any condition which obstructs the flow of bile along the ducts may cause it, e.g. gall stones, growth, etc. Many cases result from the disease called infective hepatitis which is a variety of inflammation of the li ver, sometimes infectiou s.

THE FUTURE OF THE TEAM TEST By F. C. Reeve, F.Z.S., F.R.E.S., F.I.C.A.P.

TO appreciate fully the significance of the points I hope to bring out here it will be necessary to refer back to my , Review of 18 months of Competitions,' in the MarchiApril number of last year. In the course of that review I questioned the value of the team test as at present constituted, suggesting that it had outrun its usefulness and was now rendered obsolete by present-:day conditions. I suggested that the ideal team test today would be one in which a number of casualties were scattered all over the place, calling for the highest skill and knowledge of each individual member of the team. The challenge was accepted My challenge has been accepted, first by London Transport, followed immediately by the Metropolitan Police. Both these centres are well satisfied with the results, and the competitions in which the experiments were made are reported elsewhere in this issue of the Jo~rnal.

London Transport provided the typical disaster which might be anticipated today, and with which our teams should be trained to deal. The Metropolitan Police test, whilst not, perhaps, falling strictly within the category of what we are learning to describe as 'mass casualties,' did provide three patients sufficiently separated to demand the individual attention of one competitor, whose knowledge of the text-book and skill in execution were essential. At the same time all were under the di rection and supervision of a leader. His would be the very serious responsibility of deciding upon disposal and arranging for transport. He mighf, also, undertake documentation, labelling, control of spectators and other tasks which would prevent any interruption of practical treatment by the individual members. Some examples How often do the judges tell me that they are experiencing great difficulty in finding' something new'

FIRST AID & NURSING, MARCH ,APRIL 1957

THE FUTURE OF THE TEAM TEST-Continued

to introduce into the present team tests? Moreover, as I suggested in my , Survey,' it is difficult to suggest any situation in which a team would be found already collected awaiting the disaster. Surely this is evidenced by the pathetic attempts made by the judges to create the artificial conditions and environment which alone can make this type of team test at all plausible. Let me quote a few examples: You are returning from first aid practice. The team is watching a dress rehearsal for a concert. The team is passing the open door of a house. The team is on duty at a county show. The team has been to a first aid competition. You (the team) have arrived at a friend's house for dinner. The team is returning from a first aid practice. Here follows one in which no explanation of the team's presence is attempted: The team, whilst walking along the cliffs near a coastguard station. The detachment undertakes nursing duty under the supervision of the district nurse. The incident takes place in a store. The team leader, in charge of the store, has organised a first aid team. You and your team happen to be passing an isolated cottage. You are returning home at night from a first aid practice. Your team has been driven by car to a picnic. The members of the team are walking home across country. The team is on its way to the home of a member for first aid practice. The team is returning from a first aid practice. The team has been practising at a friend's house. You and your team are waiting for a 'bus. You (the team) are on your way to an ambulance duty. An accident has happened. The team will arrive in an ambulance (where from is not stated !) You (the team) have been called

to an accident (where from is not stated !) You four have been asked to give a first aid demonstration. An accident then happens. You are on your way to a competition. You four have been to a competition. The team are standing talking. The team is practising first aid . You four are returning from a competition. The team members are preparing a first aid post. You (the team) have been taken out for a sea fishing trip. You are just leaving your first aid post. Walking along the street you (the team) hear cries. You are returning from a first aid duty. I said I would quote a few, but I have been tempted to quote a good number in order to emphasise my point. Moreover, these have not been selected but have been taken seriatim, from my file for 1955, and this clue will enable those of my readers who file their programmes to confirm. The unknown quantity Now let us get back to the L.T. test. It is the sort of incident which might be expected in either war or peace conditions today. Admitted, the members of the team may not arrive together, but, in that case, as each one arrives he would immediately commence on his own, but when the leader, or anyone capable of leading, arrived their individual efforts would immediately be coordinated. However, I am not concerned here with these details but rather with the conduct of the team and its reaction to conditions which prevail today, but which were certainly never dreamed of when team tests werefirstinaugurated. Naturally, as the ~est had been based upon the suggestIOn I made last year, I studied this competition with particular interes~. Without exception, the first reactlOn of each team was one of s~rprise at finding something quite dIfferent from the type of test with which they had always been so familiar. Instead of one obvious , main' victim, with, perhaps a second~ry of lesser importance, they recogrused that they were up against an unknown quantity-in more senses than one. Recovery was

rapid, however, and the mental attitude quickly adjusted to the new situation. From this point I feel that the judges would be better qualified to assess their valuations of the reactions of the teams, and I have asked each judge to let me have his comments. They have all ' proved both interesting and instructive, and I would like to have reproduced them in full. Space, however, will not permit, but I propose to epitomise their comments as fully as possible. Judges' comments Dr. Fyfe, who, with Mr. Harden, was responsible for devising the test, reminds us first of all that there were four casualties to be dealt with" two buried in the wrecked house and in obvious further danger from falling debris, whilst two were emerging from the rubble with the assistance of bystanders. These bystanders were of the helpful and intelligent variety, and the policeman, due in five minutes, was a skilled first aider. Dr. Fyfe believes that the success or failure of the teams depended largely upon the ability of the team leader to assess the situation, determine priorities and allocate duties to his team and the bystanders-and I would emphasise his reference to tbe instruction of bystanders. He goes on to point out that three judges at least were necessary, one to follow the team leader and gauge his assessment of the situation, and later to join the other two judges in adjudicating the handling of the injured. When the team leader was in effective control, judging was relatively easy, but when he was not, the team members, the patients and the judges had a difficult time. Dr. Fyfe emphasises the importance, in a competition of this sort, of having everyone well briefed, and a preliminary run-through is even more essential than in the more stock type of situation. I was interested to learn that the impression gained by Dr. Fyfe from this competition was that if a first aider is given a casualty to deal with he will do so efficiently and keenly. Unfortunately, however, his keenness to help the first casualty he comes across is so great that he tends to ignore the situation as a whole. Dr. Fyfe concluded his comments by saying, , The fault here

FIRST AID & NURSING, MARCH/APRIL 1957

lies, not with the first aider, but with those ' of us responsible for his training and competition practice.' He was speaking as both lecturer and trainer. Inspector Williamson brought out some interesting points. His task was to concentrate upon the competitor who discovers a concealed female patient, but before giving me his impressions of that part of the test he emphasised the important part pJayed by the staging and setting, which added considerably to the success of a competition test of that magnitude. He then gave me his impression of his section of the test. Although his patient was suffering from haemorrhage, she was often left unattended for long periods ~sometimes 7 or 8 minutes. He thinks that the reason for this may have been one of many. Often the delay occurred following a preliminary visit by one of the team, who failed to realise fully the danger the patient was in, or he may have preferred to deal with some other less exacting task. Sometimes he returned, sometimes he did not. One or two competitors who dealt with Mr. Williamson's patient were, obviously, inexperienced, and this certainly has a direct bearing upon the Inspector's next comment. A competition of that magnitude, he says, very readily finds out teams with weak and inexperienced members, and only teams with every member as good as the leader can succeed when faced with three or four patients. There is, he continues, no room for passengers in the team when confronted with a situation such as that presented by the L.T. competition. I was particularly interested in this comment of the judge, for it confirms most strongly one of my arguments for suggesting this type of test. High quality ofleadership required Inspector Williamson stated that he had heard it suggested that the test was nothing more than four , Individual ' tests rather than a team test, but he strongly disagrees with this suggestion. It is easy, he says, to act as a team, and to display leadership, when the members are clustered around one patient, but the L.T. test demanded the highest qualities of leadership and team cooperation (which was, in the main, lacking) to succeed. Commenting

upon the competition as a whole he said that he does not like it st~ged with a team test and two duals. It only needs a little luck for a weak team with two experienced members to beat a first-class team. This judge does, however, emphasise that a test of this type demands considerable space, and points to many difficulties which could be experienced by competitors, judges and patients on this account. 'It was grand,' concluded the Inspector, 'for it rules out dependence upon a good team leader.' 'This team test,' says Mr. L. M. Croton, another of the judges, , was the most unusual competition test it has ever been my pleasure to judge, for it presented a situation where the team found no fewer than four casualties and quite a goodly number of bystanders.' He goes on to say that the test demanded the utmost skill in leadership, and required speedy, accurate diagnosis from ALL (he emphasises 'all ') members of the team. This emphasis on 'all' by Mr. Croton, I feel is important. He states that the diagnosis of the casualty he was asked to watch (simple fracture of right clavicle and nerve shock) was speedily executed, and in most cases the team, quite rightly in his judgment, left the case to a junior member. One important criticism is offered by Mr. Croton, and that is that the services of the police officer might have been utilised to a greater extent. Every member of the Force is, today, a qualified first aider. Yes, I agree with you, Mr. Croton, for he could virtually be regarded, and treated, as an extra member of the team. Mr. Croton's concluding comments are inspiring. He says: 'As was expected, no team actually completed the test, but it was most encouraging to see the manner in which all teams entered into the sense of urgency inspired by the excellent staging and acting of all the patients and bystanders. It was an excellent prototype of a new type of test, and it is to be hoped that this will be emulated by other organisations arranging in ternal competitions.' Weak members of the team showed up Mr. Gates' comments were short but to the point. He states that he thought, when he first saw the set-up, that the L.T. had undertaken an almost impossible task by setting up

such a scene with four patients and that with judges and bystander; they would be treading on each others' toes. However, a practice runthrough was staged, and it was then obvious that this would be avoided. Mr. Gates goes on to say that as the test progressed he was aware that this type of competition set-up showed up the weak members of a team , and if a team wishes to succeed in this type of test, every member must train up to No. 1 standard, which, to his mind, is all to the good. It also brings out and gives scope for an efficient leader to show his mettle. Mr. Gates concludes by saying, 'It was certainly a new departure to me from the usual stereotyped team test. I liked it very much and thoroughly enjoyed it.' Judging the transport of the casualties was Mr. H. Dunford, who believes that the object of competitions should be to train teams to take part in a major incident. Although jlldging only the final stage, he watched very carefully the preliminary stages, and he agrees with his colleagues in that the new type of test develops the qualities of the individual members. In the past, he says, with the old type of test, the members leave too much to the leader, so that when it comes to treating a patient entirely on their own it is obvious that they are not entirely capable. He refers to ' disorimination,' pointing out that some failed to realise that the patient most prominently in view was not necessarily the one most in need of immediate attention. He reminds us that it is most important to make sure that the most seriously injured should be treated first, vide textbook. He feels sure that this new type of test stimulates co-ordination in a team. A full picture of the situation would enable the team to decide which of the patients should be stretcher cases and which should be transported by other means. In several cases Mr. Dunford had to debit marks because the wrong patients were treated as stretcher cases. More than one patient carried by stretcher could easily have walked with assistance. 'I really enjoyed the competition,' he says, 'and think it a step in the right direction.' Well, London Transport Ambulance Centre were always pioneers.

FIRST AID & NURSING, MARCH/APRIL 1957

Competi~ions

London Transport Competition Sister Hutchings, Gravestock and Billings Trophies THE year 1956 closed with a bold experiment, and what body would be more likely to make this venture than the London Transport Ambulance Centre? We feel that the experiment and its reaction are of so great an importance that it warrants a special article, which will be found elsewhere in this number. The experiment formed the team test in the competitions, which were held at the L.T. Chiswick Works.

St. JolIn Regional ORicers' Course THE St. John Ambulance Brigade is divided administratively into Regions -and the Hon . Mrs. Leslie Gamage, County Superintendent for Berkshire, organized a one-day course for officers from Region VI, which covers the counties of Buckinghamshire, Berkshire, Hampshire, Dorset and Oxfordshire. One hundred and forty officers attended the course on Saturday, 2nd March, at Reading Town Hall. Why you wear black The first speaker was Mrs. Smell ie, M.B.E., County Superintendent for Essex. Her subject, with which she dealt firmly but amusingly, was ' Brigade Uniform.' Mrs. Smellie reminded her listeners that tbe St. John uniform was black in continuation of the traditional mourning of St. John for the loss of the Island of Rhodes-a little later Mrs . Grosvenor, Deputy Superintendent-in-Chief, pointed out that if ever the Island of Rhodes were recaptured, St. John members would all have to wear puce uniforms. Facial injuries- practical advice The next speaker was Mr. R. L. Beare, F..R.C:S., fro~ the Plastic Unit, Queen VJctor:Ja HospItal, East Grinstead, who spoke on the treatment of ' facial injuries' and his contribution was both interesting and important. He urged that anyone who came across a casualty .with facial injuries, although following the correct St. John procedure in sending the casualty to. the nea~est hospital, should do everythmg possIble to urge that the patient should be sent at the earliest possible opportunity to one of the specialist units. This was not because surgeons at other hospitals were not excellent but because at the~e units spec!al equipment was alv. ays avadable. Dealmg WIth first aid treatment to casualties with injuries to their face Mr. Beare said that it was most importa~t to maintain an air-way, either the mouth or the nose. He urged that foreign bodies such as dentures, loose teeth, glass, etc., should be removed from the mouth. In order to stop the patient inhaling vomit or ~Iood, ~he position was naturally most Jmportant. The patient was usually safer and more comfortable if laid prone with his face to one side, or sitting leaning forward so that blood could drain away. Mr. Beare said that haemorrhage seldom ~n~angered life in the case of facial inJunes and nearly always responded to firm bandaging.

First aiders should, while waiting for the ambulance, try to remove as much dirt from the injuries as possible because the longer the dirt was allowed to stay, the more it would becol'be imbedded in the wound and further operations would be necessary to excise it. Mr. Beare reminded the audience that it was essential to look for associated injuries with these casualties, such as fracture of the skull or limbs or abdominal injuries . He recommended that both morphine and anti-tetanus injections should be given, though from the St. John point of view this obviously could not apply. Everyone present was electrified when told to collect any odd bits, such as skin or nose or ear and to send it with the patient to the specialist unit, as even if the bone could not be used the skin could well be useful. . St. John members could also be most useful by finding out details of the accident, for example whether the patient was unconscious when found, or if he lost consciousness, for how long; and also by giving a brief description of the accident, in case of later legal consequences. Turning to burns on the face, Mr. Beare said that nothing should be put on to the injuries at all. Paraffin gauze, or as the S~. John First Aid Manual reco~mends, bIcarbonate of soda would do no harm but equally would do no good. Miss L. Duff Grant, R.R.e., S.R.N., D .N., Trailing Adviser at St. John Ambulance Brigade Headquarters, spoke of the 'Relations between Adults and Cadets.' She said that the training of young people was one of the most important tasks that could be undertaken and that the important aspect of st. John training to cadets was that the emphasis was on training them for citizenship. .~olonel E. G. Dutfield, T.A., in charge of CIvil Defence at the St. John Ambulance Brigade .Headquarters in Hampshire, spoke on the Importance of St. John members joining the Civil Defence. He pointed out that C.D. was the fourth army of the forces of. the Crown and was a highly developed sC Ience. He pointed out the extreme importance of trained first aiders and the

part that they would have to play. That was why it was so important that St. John members should know how they could help and where they could help and the type of casualty they would encounter. There was an urgent need for ambulance members in the casualty ambulance sections, and nursing divisions were ideally suited to join the mobile first aid detachments or to help to look after the sick at the welfare sections in receiving areas. The last lecture was by Mrs. B. Grosvenor, e.B.E., Deputy Superintendent-inChief, st. John Ambulance Brigade, who spoke on 'The Work of St. John.' In praising the excellence of this one-day course, Mrs. Grosvenor thanked Mrs . Gamage for her hard work and generosity in organising the course. . Mrs. Grosvenor said that the day-to-day work of the Brigade changed little with the years, and it was expected of St. John that the sick and the suffering and the casualties should be dealt with, but she did urge that all those members who worked for St. John in unexciting ways, such as visiting old people week after week through the years, should be given an opportunity whenever possible of doing some more interesting and exciting public duty. .Mrs. Grosvenor backed up everything saId by Colonel Dutfield in his plea for St. John members to join the Civil Defence. She spoke also on the wonderful work done by the Brigade throughout the country in connection with Hungarian refugees and the Anglo-Egyptian expellees. Recalling that the first air unit had been formed in Berkshire, Mrs. Grosvenor said that she had heard from all sides praise for the St. John Air Attendants who had gone to Vienna to bring over Hungarian refugees. She told the audience that the St. John Hostels had been set up for AngloEgyptian refugees, many of whom came from Malta, the home of St. John. The Course was wound up by Mr. e. A. Poole, County Commissioner for Berkshire. A bouquet was presented to Mrs. Gamage by Miss Lavinia Baird, County Superintendent for Oxfordshire, on behalf of all the officers of Region VI.

Team Test The four members of the team are walking along a country road, nearing a village, when they hear an aeroplane low overhead, descending rapidly. An explosion follows, and they reach the village five minutes afterwards. Upon arrival they find that a ho:use has been demolished, and the inhabitants are buried under the rubble. There are four victims: Patient No. 1 (male): Depressed fracture of skull (frontal), compression (later), simple (or closed) fracture of right thigh, unconscious throughout-toxic shock. Patient No . 2 (female): Severe haemorrhage, left leg, simple (or closed) fracture of right arm, conscious-nerve shock. Patient No.3 (male): Simple (or closed) fracture of right clavicle, conscious-nerve shock. Patient No.4 (female): Severe haemorrhage from large wound on right arm with foreign bodies, conscious- nerve shock. The team test had been devised by Dr. J. L. Fyre, Assistant Medical Officer to London Transport, and Mr. S. W. Harden, secretary of the Centre. It was judged by Dr. Fyfe, assisted by four otber judges, Inspector D . Wj1liamson, Metropolitan Police ; Area Staff Officer, L. M. Croton, S.J.A.B.; P.e. F. L. Gates, Metropolitan Police and Area Superintendent H. Dunford, S.J.A.B., who judged the transport of the victims. There was an individual practical test and an oral test for label-holders, the oral test being conducted by Sergeant W. T. Partlett, Metropolitan Police. The Individual Practical Test, which was devised and judged by Mr. George E. Craft, the well known S.J.A.B. Competition Secretary, was as follows: Tbe competitor finds his friend, who has been working in the garden, has fallen from a ladder, and he is called upon to diagnose and treat the following injuries: Fractured right clavicle, slight haemorrhage from a wound on the right hand . At the presentation ceremony the chair was occupied by Mr. K. G. Shave, VicePresident of the Centre, who apologised for the unavoidable absence of the Chairman, Mr. Alex J. Webb. He was supported by Dr. L. G. Norman, Principal Medical Officer, London Transport, and VicePresident of the Centre, Mrs. Harden, Mr. W. 1. Kirshner, and the judges. The chairman welcomed the 13 teams who had survived the preliminary ordeals in which 70 teams had taken part, and thanked the visitors for their continued support. He commented upon the novel

test they had witnessed that day which, although it was generally agreed had proved a difficult one, the competitors had attacked in a most efficient manner. It had aroused a great deal of interest, and he hoped that it would also assist in bringing in recruits. Mr. W. I. Kirshner then proposed a vote of thanks to the judges, a most able body headed by Dr. Fyfe, who had carried out their exacting tasks most conscientiously and with the utmost impartiality. In response to an invitation from the chairman, Dr. Fyfe commented, on behalf of his colleagues, upon the work of the teams in the team test. He said that it was difficult to find a suitable adjective with which to describe the reactions of the teams to this new type of test, but one thing was evident, and that was that the standard of work improved each year. One of the objects of the test was to improve the leadership. There were four tests, and it was the duty of the leader to assess the relative importance of each one's injuries. Speaking of the use of observation he drew attention to the dangerous roof, which threatened to fall at any moment. In selecting bystanders to render assistance, they must exercise commonsense, and always bear in mind that, today, all police officers are first aiders. He referred briefly to the requirements of each individual patient. No. 1 was in danger from the possible fall of roof, therefore the minimum of treatment shoutd have been carried out in order to make it possible to remove him from danger as soon as possible. In the case of No.2 patient, too much delay occurred before attempting to control haemorrhage, and even then the bandages were too slack. Commenting upon the transport, Dr. Fyfe said that in many cases the wrong patients had been carried by ambulance. Two of them could have managed without help. However, he felt that he must congratulate the teams upon the manner in which they had attacked this unexpected departure from tradition. Mr. Craft commented upon the work of those taking part in the Individual Prac-

tical Tests.

He said that the removal of in awkward positions, reqUIres practIce. If done correctly the garment comes off easily. In fractured clavicle they must not forget to undo the braces on the injured side, although, perhaps, he ought to excuse the lady competitors if they failed to find the brace button. The bandage bracing back the shoulders was often not pulled tight enough . The results were then announced by Mr. Harden, the Centre secretary: 1. Baker Street (Women) .. . ... 342 (winning the Sister Hutchings Cup) 2. Chiswick 338 3. Reigate (Women) 332} (winning the Gravestock Trophy) ~ 4. ManorHouse 317~ 5. Romford 'A' 314 285-!6. Dorking 7. Sutton (Women) 247t 8. Sidcup 243 9. Bexley'B' 231t 10. Dunton Green 'B' 198t 11. Sutton'D' I97t 12. Hertford... 195~13. Dartford 16l}

jack~t,

especi~lIy

ORAL TEST 1. Mr. J. P¢nney (New Cross) (winning the Billings Trophy) 2. Mr. A. Sheen (Romford) 3. Mr. G . Hart (Manor House) ... 4. Miss L. Duckett (Baker Street). .. 5. Mr. W. Henley (Sidcup) 6. Mr. C. Bullett (Kingston) 7. Mr. D . Mayo (Addlestone) 8. Mrs. E. Read (Northfleet) 9. Mr. A. Fatheriey (Dartford) 10. Mr. H. Berry (Chelsham) 11. Mr. D. Large (Chelsham) 12. Mr. B. Hawkins (Godstone) 13. Mr. J. Davies (Kingston)

47 45 40 31 29 22 22 14 13 II! 11 9 8

Mrs. Shave then presented the trophies to the successful competitors. A vote of thanks for presiding and an expression of appreciation of his practical orman interest to Mr. Shave by Dr. brought to a close a most interesting event.

Metropolitan Police First Aid Finals The Parsons, Turnbull and Vivian Rogers Trophies pERHAPS the highlight in the Metropolitan Police first aid is the competition for the Parsons Shield, which also forms the eliminating round for the National (' Pim '), and this was held at Macnaghten House, W.e.l. The 'Met.' were quick to recognise the possibilities of the new form of team test, suggested in First Aid and Nursing last year, and to try out the experiment of staging one based upon these lines .. It proved a great. succes.s . In view of the lIDportance of thiS test In the changing pattern of the team test, and its somewhat involved character, it is felt that the outline should be given in full.

THE TEAM TEST In which there were three victims, was judged by Dr. C. J. P. Seccomb.

Card given to the team: 'You four have assembled at a police box to report for duty. You will act upon any informa~ion received or instructions given.' Stagmg: Two houses, Nos. 20 and 22, Pim Road, W.C. No. 20 will show living room with table chairs etc. No. 22 will show kitch~n with' gas cooker, etc., and li,:,ing room with table, chairs, etc. There is a telephone at No. 20. .. . Settings: Patient No.3, whilst Sl~tlllg at the table, is stabbed from behmd by patient No.2, and coJlaI?s~s over the table. He is found in this pOSltJOn by the team. Patient No. 2 then enters the kitchen, closes doors and windows and attempts suicide by coal gas poiso~ing. J:Ie is found lying on the floor with hJS head lD.the gas oven when the team arrives. PatIent

No. 1 (Mf. Parsons, of No. 20) senses a strong smell of gas coming from his neighbour's house (No. 22) and rings the police. Before the police arrive he tries to break in, and in doing so puts his hand through the window, sustaining injuries. As the team arrives he meets them with blood pouring from his hand. The information received at the pclice station is passed on to the team who are waiting at a police box to report for duty. The test starts as the team leave the box. Examination of each patient reveal~ the following injuries: Patient No.1: Wounds in right hand, severe haemorrhage, glass visible and removable, glass embedded and tendon of index finger damaged. Patient No.2: Asphyxia from coal gas poisoning, coma. Patient No.3: Stab wound on right shoulder, behind clavicle, injury to right lung, internal haemorrhage, haemorrhagic shock. Some further notes wiJl be found in 'The Future of the Team Test' which appears elsewhere in this number. The presentation ceremony was presided over by Captain Rymer Jones, O.B.E., M.C., Assistant Commissioner, of Metropolitan Police. As the marks had not }et been totalled he asked Dr. J. C. Graham, who had set and judged the Individual Practical tests, to give his comments. Dr. Graham commenced by reminding the competitors that he had already given them privately some individual advice at the conclusion of each test. Both the Individual tests had been quite straightforward, one a boxing disaster and the

FfRST AID & NURSING, MARCH/APRIL 1957 other a domestic accident. In the case of the boxer, the approach had been good. He referred to the change made in the text-book relating to the position of an unconscious patient, and said that it had been made in the light of actual experiences. After head injuries there was always a danger of asphyxia as a result of swallowing vomited material, and he impressed upon his hearers the importance of bearing this in mind. Whenever the breathing of an unconscious patient was noisy, this was an indication that he must be turned over to the three-quarter prone position immediately. In the case of fractured jaw, also, this position assists drainage. In the second test they had usually been bandaged well. Referring to the fainting of the wife, a faint was often treated as of greater importance than the main injuries. They must try to exercise a sense of proportion. He was followed by Dr. Seccomb, who had judged the Team Test. Dr. Seccomb said that the test had been devised with a view to testing the qualities of leadership. There were three patients, and of these one was getting better whilst one was getting worse. It was for the leader to decide which of the patients demanded the more immediate attention. Coming to details, he said that the tourniquet shouJd have been applied further up the arm in most cases, and he had noted that only six teams recorded the time of application in writing. Pulse-taking could have been better, and in A.R. the position of the hands was not always correct. By now the marking sheets had been completed and the results were announced:

1. 'J'Division

293t (winning the Parsons Shield and the Turnbull Cup) 2. 'A'Division 274 (winning the Vivian Rogers Cup) 3. 'M'Division 25% 4. C.O., D.3 (Training School) 252t 5. 'L'Division 252 (winning the Parsons Plaque) 6. 'W'Division 244 7. 'Z'Division 241 8. 'Y'Division 235 9. 'V' Division 22lt 10. 'R'Division 21lt In presenting the trophies to the winners, Captain Rymer Jones said that it had been a good competition, and all the tests had been interesting. Certainly, it had been a 'surprise' result, but he felt certain that all were quite satisfied. He thanked the stewards, patients and 'fakers,' timekeepers and especially the judges, who had so kindly given their time and skill in this great cause. They were most grateful to 'E' Division, Metropolitan Police, for having placed this fine hall at Macnaghten House at their service that day. Mr. Harden had been responsible for the scenery. He remarked upon the great debt they all owed to the teams. Be had heard it said that' first aid is finished', but he was sure that what they had seen that day was sufficient answer to this criticism. 'Good luck to you all in your first aid activities,' he concluded. The arrangements for the event had been in the capable hands of the competition secretary, Inspector D. Williamson.

Police National Finals The 'Pim' WERE so many policemen ever seen together before? There were policemen in blue, policemen in green from Northern Ireland and policemen with draught-board cap bands from Scotlandhundreds and hundreds of them, a veritable 'policemen's holiday.' Yes, you have guessed. It was the 'Pim,' held at Porchester Halls, Bayswater-and what enthusiasm! There were eleven teams, repre~enting the eleven Districts into which the United Kingdom is divided for administrative purposes- and how they tackled those tests ! Team Test, set and judged by Dr. R. ScottReid, of Bath: The team is called to a man who not quite as sober as he might be, has fallen into a hole in the road excavated bv the local Gas Board. It is a dark night~ Injuries: Compound fracture of left tibia, simple fracture (mid-shaft) of right femur, abrasions on palms of both hands, nerve shock. Dual Practical Tests, set and judged by Dr. James Baker, of Sheffield: Nos. 1 and 2 are called to a man who has met ~ith an accident and is found sitting in a chaIr. A novel feature is introduced into the test by the fact that the patient is a deaf mute, and all conversation has to be translated by his mother in the deaf and dumb alphabet. Injuries: Simple fracture of left clavicle nerve shock. ' Nos. 3 and 4 find a man slumped in a

chair. He is cyanosed and breathing very feebly. Injuries: Poisoning from carbolic. Opening the presentation ceremony', the chairman, Mr. Horace F. Parshall, T.D., M.A. (Oxon.), Director-General of the St. lohn Ambulance Association, who was supported by Sir Frank Newsam, KC.B., KB.E., C.V.O., M.C., Permanent UnderSecretary of State, Home Office, welcomed their guest, saying how fortunate they were in having him with them that day to present the trophies. He also extended a cordial welcome to Major-General J. M. Kirkman, c.B., C.B.E., the new Commissioner-inChief of the St. John Ambulance Brigade, on his first visit to a S.J.A.A. competition. It was also, he said, very encouraging to see so many chief constables from the various counties who had come to support their respective teams, and also many representatives from the Home Office. The teams themselves had, obviously, been followed by a large number of supporters many from long distances. He extended his grateful thanks, and the thanks of all to the stewards, the time-keepers the St: John-trained' fakers' and 'patie~ts,' and all who had had a hand in making the event a success. He particularly wished to thank the judges who were always so ready and willing to help in this great movement. For the scenery they were again indebted to the Associated British P~cture Corporation Ltd., without whose kmdness the tests could not possibly be

made so realistic. 'Keep on with the good work,' he concluded. Unfortunately Dr. Scott-Reid had had to leave early, so Dr. Baker commented upon the work of the team in the Dual Tests and also spoke for Dr. Scott-Reid. He opened by appreciating the honour which he said had been conferred upon him by having been invited to judge a major competition, especially as he was a ' new boy,' although he had judged many smaller competitions. However, it had been a pleasing and valuable experience for him. His first impression had been the unfailing courtesy of the teams to the judge, which had made his task so much easier. 'I have been bandied well,' he said. Commenting upon the (intentional) handicap suffered by the teams by having to deal with a deaf mute, he pointed out that some of the channels of , observation' were closed- the use of their ears and speech. However, there were still some points which they could, and should, have observed. If they had looked up they would have seen the line of washing which would have provided improvised bandages. If they had looked down they would have seen tbe banana skin which was still a source of danger. If they had used their noses they would have smelt poison, for carbolic possesses a very characteristic odour. Otherwise the tests were all straightforward, with no traps. The only real criticism he had to offer was that of rather rough handling, but even that may have been the result of overen t husiasm.

FIRST AID & NURSING, MARCH/APRIL 1957 Lieut.-Colonel E. C. Croft, Deputy Director-General of the St. John Ambulance Association, then announced the results: 1. Exeter City Police

378 . (winning the' Pim ' Challenge Trophy) 2. West Sussex Constabulary 377 (winning the' Police Review' Challenge Cup) 3. Liverpool City Police 'B' 376 4. Dudley Borough Police 375 5. Edinburgh City Police ... 371 6. Royal Ulster Constabulary 370 7. City of London Police 'A' 36] 8. Bradford City Police 'B' } tied 347 8. Swansea Borough Police 10. Metropolitan Police (J Division) 331 11. East Riding Constabulary 329

The chairman invited Sir Frank Newsam to present the trophies, but before calling for the winning teams a plaque was presented to Mr. Fred Argyle, the well-known competition leader, of 'L' Division, Metropolitan Police. This was greeted with loud applause, for' Fred' is very popular. In presenting the trophies Sir Frank said that, whilst he was pleased to make the presentation, he did not like the second part of the invitation-to make a speech ! Emphasising the value which the Home Office attach to the police, he reminded his hearers that the possession of the St. John First Aid Certificate considerably im,reased their efficiency. He thanked the Association, and the Director-General, for their valuable work in this direction. Without such organisations as the Association public life would be far more difficult. Today first aid forms a very important part

of a policeman's duties, and he reminded them of the first aid work done by the police during the last war. After all, it is not the size of the Force which counts, but its efficiency, and this includes first aid. He was proud to tell them that 180 teams had entered for the preliminary competitions, and 153 had actually competed. Much of the success of the police in first aid was due to the enthusiasm of the Chief Officers throughout the country, and for this he was most grateful. He hoped that the interest of the police in first aid would be maintained, and concluded by again thanking the St. John Ambulance Association on behalf of the Home Office. Mr. Parshall thanked the police for the facilities which they always afforded the Association, and said that he was anxious to see an ever increasing standard of effici ency.

Electricity Finals IF evidence is needed to support the claim that interest in first aid is yearly increasing in the 'electricity industry it can be furnished by two facts. First of all the Annual First Aid Competitions, which were held at the Porchester Balls, Bayswater, were considered of sufficient importance to warrant the attendance of the Rt. Hon. Lord Citrine, P.c., KB.E., LL.D., to present the trophies, provided by the St. John Ambulance Association, under whose auspices the competitions were held, and, secondly, the fact that 23 teams, 12 men's and 11 women's, had entered for the event. As usual these teams had to face a team test and dual practical tests, all of which proved most interesting. Men's Team Test, judged by Dr. Lancelot K Wills, of Willesden: The team is crossing a field when a distant cry for help is heard. A young man is calling for help for his friend who, whilst wearing a frogman's outfit, has tripped and fallen heavily, striking his head against a stone, and is lying on the ground. Injuries: Wound on forehead, bruising over right temple, concussion, simple fracture of right clavicle, simple fracture of right tibia. Women's Team Test, judged by Dr. W. N. Booth, of Harlow: Visiting a friend's house they are met at the door with the news that their friend has fallen when the electric lights failed. Injuries: Concussion, severe scalp wound on right side, bone exposed, fracture of humerus, upper third, fracture of right patella. Men's Dual Practical Test, judged by Dr. R. Renwick, of Watford: Nos. 1 and 4 are called to a house where they find a man lying on the floor with an open razor in his hand, evidently having attempted suicide. .. Injuries: Severe wound of rIght wnst, concussion. The test for Nos. 2 and 3 is also a domestic one. A man was filling a teapot with boiling water when he spilt some over his hand and then slipped on the floor. Injuries: Scalds of left hand and wrist, with blistering, sprained left ankle, nerve shock. Women's Dual Practical Tests, judged by Dr. S. Hulme, of Sutton:

Nos. 1 and 4 are called to an elderly lady who has tripped over the edge of the carpet and fallen to the ground. Injuries: Fracture of neck of femur, right Calles' fracture, toxic shock. Nos. 2 and 3 are called to a workshop. Here they find a man who has caught his hand in the fan of an engine. Injuries: Severe wounds of index, middle and ring fingers of right hand, with underlying fractures, nerve shock. The Director-General of the st. John Ambulance Association, Mr. Horace F. Parshall, T.D., M.A. (Oxon.), presided at the presentation ceremony, and was supported by Lord Citrine, General Tyndall (Director-General of Civil Defence) Major-General J. M. Kirkman, C.B., C.B.E. (Commissioner-in-Chief, the St. John Ambulance Brigade), Lt.-Col. J. E. F. Gueritz (Secretary, the St. John Ambulance Association) and the judges. Amongst those present we also noticed that staunch supporter of the competitions, the Hon. Mrs. Leslie Gamage. Opening the proceedings, Mr. Parshall expressed his pleasure in ,,~elcoming Lord Citrine who had once agam graced them with his presence, and had kindly consented to present the trophies. He (Mr. Parshall) would let them into a secretLord Citrine gained his first aid certificate many years ago, a fact which was largely responsible for his great interest in the movement. He also wished to include in his welcome the new Commissioner-inChief, Major-General J. M. Kirkman, c.~., C.B.E., and he knew that he was speaklDg for every member in his audience. They were also very pleased to have with them Dr. J. L. Houston, from the Home Office, Col. Dyer and many others. Once ~gain their thanks were due to the ASSOCIated British Picture Corporation Ltd., for their continued valuable help by pro\iding, erecting and removing the scenery. Special reference was made to the backcloth for the Men's Team Test. It was certainly a work of art, and had been admired by all who had seen it. Again the stewards, timekeepers and the St. John-trained , fakers' and patients had contributed .to the success of the event, together WIth many others he would like to have named. Last of all he mentioned the judges, t~ose professional gentlemen (and, sometImes

ladies) who were always so willing to give of their time and skill, and without whose help these competitions would not be possible. Moreover, their comments and criticisms were always regarded as most helpful, and he asked Dr. Wills to give his comments on the Men's Team Test. After briefly outlining the test, Dr. Wills came to his first point. The patient was unconscious and should not have been removed until his spine had been examined. In examining the head all had not realised that there were a bruise AND a cut, an important fact which should have been taken into consideration in conducting the diagnosis. There were, he went on, two main problems, viz., how to obtain an ambulance (they were out in the country) and what to do in the meantime. In more than one case he had had to debit marks because one of the competitors had walked into the lake, which must have been deep to warrant the wearing of frogman's outfit by the patient. He criticised the bandaging in some cases as not being sufficiently tight to afford the support for which they were intended. The clavicle should have been attended to before turning the patient, and in those cases in which it had been supported the bandages became lo,?sened in turning. Whenever an overcoat IS used as an under blanket the pockets should be emptied, as it is most uncomfort~ble t~ be lying on some hard objects WhICh mIght have been in them. Raising the head and shoulders, supporting the head and turning it to one side should be the task of one competitor. Dr. Renwick had asked him to make two comments for him. In some cases the handling had been rather rough whilst in others the examination had not been sufficiently thorough. In his (Dr. Wills') own test he had found the examination thorough on the whole, but rather , sketchy.' Dr. Booth, who followed Dr. Wills, stated that many of his comments would be similar to those of Dr. Wills. However, British Electricity girls certainly had' hot points,' a joke which the audienc~ were quick to appreciate. In general, therr work had been almost perfect, and they had failed only on small thing~. 'They ~ould. ' he said 'insist upon talkmg to me JDstead of to e~ch other.' The usual cry . ' ~e're first aiders ' was unnecessary as theIr fnend

FIRST AID & NURSING, MARCH/APRIL 1957

10 would know this. He saw the padding , pushed in ' after the bandaging had been completed. They should realis~ that the padding performed a most In:porta~t function, and they should not Insert lt merely because the text-book says so. !he old squabble about 'te~ before hospItalisation ' cropped up agam, and. he hoped that this would be settled finaIIy m the new text-book. He had spent a very happy day. In asking Mr. George Craft, the Competition Secreta~y, to. ann<?unce the results, theChairman palda hIgh tnbuteto Mr. Craft for his many years of service in that capacity. MEN 1. L on (Fulham) (Winning the Challenge Trophy) 2. Eastern (Watford) ... ... 3. Southern (Swindon) 4. South Eastern (Brighton) 5. North Eastern (Darlington) 6. Yorkshire (Hull) 7. East Midlands (Kettering) 8. South Western (Poole) 9. Midlands (Stourport) .. , 10. North Western (Lancaster) 11. South Wales (Tir John) , ] 2. Merseyside and North Wales (Clarence Dock) WOMEN 1. Southern (Swindon) (winning the Challenge Trophy for the fourth year in succession)

307 296 286 ~

285 277 273t 273 270 267 255 252i 207 363

2. South Eastern (Kingston) 3. Midlands (Gloucester) ... 4. East Midlands (Kettering) 5. North Eastern (Newcastle) 6. Yorkshire (Sheffield) 7. South Western (Bristol) 8. North Western (Blackburn) 9. Eastern (Milton HaU) ... J O. London (Bexley Heath) 11. South Wales (Cardiff) . ..

354 336l 335 324l 315 314 292i 292 290t 237t

'Well done, Swindon !' exclaimed Mr. Parshall from the chair. In a long and stimulating speech, Lord Citrine regretted that it had not always been possible for hIm to attend this important event, but whenever he had attended be had always enthused at the enthusiasm of those taking part. 'We are a new organisation,' he said, 'although there were some individual certificate holders previous to the formation of the Centre (Lord Citrine was one of these) . In a competition there are bound to be some better than others, and there can only be one winner. I was never fortllnate enough to win anything in my life,' he said, adding amidst laughter, 'except a wife.' He said that he knew full well the feeling after trying hard and then just falling short of achieving success, They cannot all be winners, but they must aU try to excel in whatever they undertake. He was pleased to hear the judge say that 'our girls' are almost perfect. The men ought

to be a little more hardened to take criticism. He wished that they all, including himself, possessed the qualities which went to make up the eight-pointed star. From his comments upon technical points it was obvious that he had not forgotten his early first aid training, a point which was not lost on his many hearers. He hoped that they would all benefit from the sound criticisms of the judges. 'Although we are a young organisation,' he went on, 'I yearly see tangible marks of progress. I have seen the numerical strength of the organisation increase from 6,000 to 9,600 since I came here.' (Cheers). He thanked the St. John Ambulance Association, with its Director-General, for the grand work they were doing, and noted especially the impartiality of the competitions. After congratulating the Swindon ladies, who had won the trophy four years in succession, he presented the trophies to the successful teams. In thanking Lord Citrine for so kindly coming there that day to make the presentations he said he (Mr. Parshall) knew that his speech consisted of no empty words, and he knew that they had all felt it to be most inspiring. The progress which had taken place in the Electricity Centre had been largely due to his inspiration togetber with the work of their Medical Officer, Dr. Pringle.

From a seat in the audience Some Random (and Provocative) Comments on the Competitions Sister Hutchings 'Is this dirt or a burn 1- ' You should have been able to decide. The patient was well made-up. . Policeman should have been asked to help. Sufficient use is not made of bystanders. No one enquired about the pilot. Bystanders must not act as experienced first aiders, but sbould only carry out the detailed instructions given by competitors. It was not clear whence the tea had been obtained. Was the chair safe or not? He ultimately decided that it was not. Not all thought to send for the fire brigade. Fancy asking a bystander to take the patient's pulse! Patient must NOT be left unattended under any circumstances. Congratulations to the two lady bystanders whose natural acting in the circumstances was excellent. , Did anyone here see what happened? ' Surely it was obvious. , ' Phone doctor, ambulance and anything else you can think of. ' , Hi ! guv'nor, she ain't 'arf making a funny noise.' Bystanders! Don't volunteer to help unless asked and given detailed instructions. You MUST act the' muggins.' Don' t try to do too much yourself when help is available. It was obvious that some had had little experience in loading into upper berth. We didn't like the way that some competitors pusbed helpers out of the way. The absurdity of using empty vessels was

well illustrated when a cup, which had just been knocked over, was offered to a patient as a • cup of tea.' Let's have realism in this as in other things. Lifting and transport was not all that might have been desired. Surely releasing the patient was more important than unpacking first aid equipment. Because you see haemorrhage don ' t jump to the conclusion that there must be a fracture. P.e.: 'Anybody hurt?' There were four patients lying on the ground. 'I can't remove the glass.' He didn't try. Surely the first thing necessary was to get the victims out of the debris, not play about with blankets. We've been told that a policeman always sucks his pencil. Now we know that it's true. Parsons Shield We saw some unorthodox methods of turning the patient. Holding your hand before your face is no substitute for a mask (gas). We only saw one team go in on hands and knees-and they stood up when they reached the gas-filled kitchen ! Don't be afraid to lift that arm in H-N. • Any help available?' Too much reliance is put upon this. · Do it yourself. • What is your address?' The patient was in his own home. Shock was treated last instead of first. , Is this your own wife? ' Fancy addressing the wife as ' my dear' in the presence of her husband!

How quickly that tea was made. Did that contusion require so meticulous ail examination to establish? Ten seconds are not half-a-minute (pulse-taking). Were two ambulances necessary? The patients were next-door neighbours . , Shall I put the kettle on myself ?' We would not advise this. Fanned the patient from a distance of It yards! 'Lie still, old chap.' The patient was unconscious. Surely the smell of gas should have suggested the necessary action. The fore-and-aft lift is not used as often as it might be. These were policemen. , Has he passed urine?' Find out. Pulse-don't guess at it, please. A simple faint requires a minimum of treatment, and should certainly not delay attention to more serious cases. 'I don't want you to speak '-but he was asking the patient a dozen questions. Tested for crepitus-a heinous crime. Did he expect the layman to know where the brachial artery was? 'This tea is nice and hot '-tbe cup was empty. Pim Wasn't that poison bottle just a little too prominent? Don't stop A.R. to ask if patient is still not breathing. The judge will tell you without being asked. , Rapid' examination is often interpreted too literally. Could he take a drink in that position?

FIRST AID & NURSING, MARCH/APRIL 1957 Surely one of the four could have gone down the hole without delay. We're getting tired of that reiterated, parrot-like' We're first aiders.' There is still too much drama . Act naturally. Oh! Those hot water bottles on the tummy again! Police teams are always good at stretcher drill.

, Anything we can use for bandages?' There was a string of washing dangling above his head . Don't say merely , bicarbonate.' There are other bicarbonates beside soda. Now whom do you want, Inspector, No. 1 ~r No.2? Make up your mind. Insufficient precautions against possible fracture of spine were laken before removing patient. One judge was decidedly too helpful. Competitors often adopt a far too familiar attitude towards wives and other female bystanders. Pads in the armpits (clavicle) should be more solid. She performe'd the deaf and dumb alphabet like an expert. . Do pins form part of the regular eqUIpment of a pol iceman? Timing was bad in A.R. by nearly all teams. Soda bic. should have been well stirred. Would the average housewife know what a 'triangular' is? Be more explicit. There should have been a larger selection of kitchen articles on the shelves, not merely those which would be required by the team. Don't commence 'phoning until you or your leader have decided what or whom you want. Judges should not allow competitors to take too much for granted. 'I'm sterilizing my fingers.' How on earth was he doing it? Why bring that cup of te~ ~efore breathing has been restored? WIll It not get cold? Few examined the spine before commencing A.R. Brought a cup and saucer straight from the cupboard and called it a ' cup of tea.' Is it necessary to go througb the whole gamut of signs and sym ptoms of fractu!ed clavicle? Surely the two nrst classlcal signs are almost diagnostic. Electricity How many forget to raise the limb (haemorrhage) ? That tea is so often produced too quickly-often before consciousness has been regained. Ambulance or bed, which? Th~ former has become a fixed habit. Thmk first before deciding. 'Do you feel weak? '-a nother leading question. Suggestion to judges: Keep an engagement book- and consult it occasionally! No, we will NOT refer to her black undies. How couJd they miss that patella? It stuck out a mile. , Muggins ' didn ' t know how to prepare or blanket stretcher! Well acted, Fred. Don't describe your every action. The judge can see what you are doing, , Is this indoors? ' Couldn't she see? Wbat a strange method of ' testing for limpness. '

How could she discover 'shortening' when both legs were flexed? We saw that helpful juoge again. It is not necessary to impress upon the j ud ge that you are moving the patient , gently.' That is for him to judge. He may not agree ! Don't you know that it is a heinous crime to step over the patient? , Stick to the text-book and you can't go

wrong.' This applies to judges as well as competitors. Where did the hot water bottles corne from? They were miles away in the country. 'Did you test the stretcher?' It was already loaded . , Promote circulation.' We counted four different methods-and not one was correct.

, Fake.·s ~ and , 'F aking ~ MUCH water has flowed under London Bridge since the early days of competition tests, when cards were attached to the' patients' denoting their injuries, two chalk-marks on the floor indicated railway I ines or h alf a dozen chairs represented the interior of a 'bus. Probably this may appear fantastic to our present-day students, who have grown up 1I1 an enviro nment of elaborate scenery and well made-up actors and actresses, yet this transition has been a comparatively rapid one, commencing with the simple application of some red substance to represent blood. Today this has developed into a fine art and certain individuals, who must be expert first aiders, are specialising in this branch of the work which is now recognised as a necessary part of every competition. Instruction classes are held where the students are trained to make-up, or ' fake,' the 'patients' and the 'patients' are taught to act the part of injured or ill persons after acquiring a thorough knowledge of the outward signs whic~ .characterise the respective morbId condItIOns. It was with great pleasure that I accepted an invitation from Lieut.-Colonel R. A. Payne, District Staff Offict::r and Distri~t Training Officer, No. 1 (Prmce ?f Wal~s ) District, to visit one of these lllstruct~on classes which was one of a course bemg condu~ted at St. John's Gate. Col. Payne insisted upon introducing me to the class, despite the fact lhat.I already knew most of the staff, after whlcb I was given the freedom of the hall. Tables were arranged in a horse-shoe, and each student had a table to him /herself, on which were displayed grease paints, brushes, plasticine and other modelllllg c;:lays, rabbit bones, splinters of .wood and bIts of glass, lipstick, n~il varmsh.es and a vast amount of impedImenta whlch woul~ have bewildered the average layman. ThlS was an elementary course for beginners, so that I was not treated to a vision of those horrible sights which greet me .when I go backstage at the various coo:petltIOns, s~ch as abdominal wounds With protrudlllg viscera, terrible burns and sc~lds and large, gaping lacerated wounds whlCh have been torn by moving machin~ry. At. the s~e time it was most interestlDg and mstructlve to follow the first steps which would eventually lead to the ability.of t~e st,udents to execute this advanced fakmg. The session had been divided into two parts, and the first opened with a lecture by the instructor District Staff Officer S. W. Broom. After referring briefly to the uses of the various materials which the students bad before them on their. t~bles, a~d warning them against commlttmg certam errors, he commenced to sho~ them how to build up a simple swellmg,. demonstrating his points upon a model slttmg on

a stand which \\as illuminated by three arc lamps. He stated that in his 'ex ;~~'i ence Harbutt's plasticine had proved the most suitable for this work, particularly as it could be used over and over again. 'Don't put a large piece on to commence with,' be warned. 'You can always add as required. ' He sbowed hpw the material should be flattened out roughly to the required shape, the finer points being completed later. Having produced a lovely swelling he went on to show how, with the aid of a modelling tool, the swelling could be cut across and a large gaping wound produced, whicb was then filled with colouring matter to represent blood, either fresh or partly congealed. When he had finished I defy anyone to distinguish this imitation from the real thing. In another demonstration he introduced a piece of rabbit bone into the artificial swelling, which had been specially shaped , to produce a compound fracture of the ulna, which was most realistic. After this a comminuted fracture was shown , again wi.th the warning tbat it is easier to add than to take off. Sometimes, when time peimitted, he used a mixture of plasticine and putty, but whatever is us~d it must be well worked up before applymg. In fact, during the whole of Mr. Broom's lecture, tbe students had been \~orking up their material ready for the practical part of the session which would follow . The lecturer then went on to deal with the question of colour, emphasising the i~port.ance of matcbing exactly the surroundmg tIssues, as no two persons had the same shade of skin colouring. With regard to blo~d, this had always proved a c~ntroversJal question, for so many had thelr 0":"ll 'pet methods and materials. For small mClsed wounds witb freely flowing blood, he believed that nail varnisb had proved the best but tbey must find out for themselves whi~h they preferred. ' Reddo' red, obtainable at Woolworth's Stores, had also proved very efficient. An excellent fO~D?ula was to be fouod in ' First Aid CompetltJOps and Make-up' by Major A. C. Wblte Knox Principal Medical Officer of the St John Ambulance Association. I c<?uld ~ot help admiring one very valuabl~ hmt WIth which the lecturer concluded, VIZ., the use of beer bottle tops as paint palette~. The second half of the seSSlOn was devoted to practical work, and, as I w~lked round the students' tables with the aSSIstant instructors, Messrs. S. J. Dear, H. A. Bignell (everyone knows Harry), A. J. Hayward and Miss M. Thomas (everyone knows Mary) I marv<:l:ed at the many morbid conditions WhlCb can be reproduced by these skilful oper.ators. . I had spent a most mterestmg and instructive evening. F.e.R.

FIRST AID & NURSING, MARCH/APRIL 1957

Casualties Union News PUBLICITY

Compiled by W. A. Potter

iJiustrated booklet, . A Brief History of Casualties Union.' Enquirers will be able to read in this welJ illustrated booklet, just how the Union came into being, and how the Union's work in peace time grew out of the need for realistic training in war time rescue and first aid work. The first part of the new book, • Atlas of Injury,' goes to press in June. This should prove of great value to all members and instructors. It is hoped to publish additional parts in the future and eventually have them all bound into one volume.

'NESTOSYL' Ancesthetic-Antiseptic Preparations For the treatment of lesions or bruises, of the skin

COMMENTARY A reduction in road fatalities in Britain last year is a matter for thankfulness, but it also serves to remind us that one in 10,000 are killed on the roads each year and one in 200 hurt. The picture is similar in other countries. How urgent then is first aid training? No thoughtful person can escape the responsibility that he ought to be ready to render first aid at any time. It would be a grand thing if all adults could be given a course of training by the voluntary aid societies-a course made practical, vivid and memorable by illustration and handling of skilled casualties. The key is interest and usefulness, made vivid by realism, not just occasionally, but at every training session.

BUXTON TROPHY Friends of the Union have helped greatly by their comments, and suggestions concerning the annual contest. As a result the rules have been modified and will enable both men and women to compete on more equal terms, and enhance the value of the contest. There are also new plans for extending the scope of competition in Scotland. OPEN PHOTOGRAPHIC COMPETITION-£tO PRIZE Casualties Union journal offers £10 in prizes for photographs of ' casualties' in action. Photographs can be entered in any of three classes. The winner in each class will receive £2, runner-up £1 and third prize is 5/-. The best photo among the c1a~s winners will receive an extra 5/-. EntfIes should be accompanied by the sender's name and address attached to the photo in such a way as not to dint or cover the photo, and should reach the Editor, 316 Vauxhall Bridge Road, London, S.W.l., not later than 31st August, 1957.

* First-Aiders Crossword No. 27

M ARCH saw the publication of a new

CASUALTIES UNION DAY The Union hopes to arouse interest in the study of civil rescue by staging a special contest on Casualties Union Day. The idea is to set a problem which competing teams can study for several months in advance, decide the best method and number of workers to form the team . The team will submit a written description of the method devised which they will demonstrate on the day. Judges will compare the methods to determine the team gaining the most points for control, simplicity, speed and gentleness. All information from Casualties Union, 116 Vauxhall Bridge Road, London, S.W.l.

FIRST AID & NURSING, MARCH/APRIL 1957

and

the

orifices.

mucous

membrane

of the

natural

Rapid ancesthetic action due to

the advantage of an association of ethyl and butyl esters of para-amino-benzoic acid. NON-TOXIC: NON-IRRITANT May be prescribed on Form E. C. 10

1. 6. 9. 10. 12. 14. 16. 18. 21. 22. 24. 26. 29. 31. 32. 33.

ACROSS Adenitis with B.O. give immunity (10) Sight of a hypermetropic (4) All return to a degree for this (5) animal Surgical 19 (9) Heat as in debility (8) A laceration shows sorrow ... (I, 4) A simpleton takes no dole (6) Send away a repair finally (8) Lousy sort of parasite ... (8) May denote serious ophthalmic condition. Always arrange for medical advice (3, 3) (5) Teach art in another way A set pair become unwelcome 'visitor' (8) Toolfor the job (9) Honour takes a point for stout (5) Compound . (4) City of gynaecological operation (10) DOWN Al at first, but is unwell

(4)

2. 3. 4. 5.

7. 8. 11. 13. 15. 17. 19. 20. 21. 25. 27. 28. 30.

We must be sure that it i~ safe, steady and speedy (9) Symptom of dyspepsia after water (5) • Doctor acknowledges and asphyxiates (6) Sheep takes a variety of little Scotch (3) Exhortation not to die for . . . . .. enema oil (5) Important cause of blindness in infancy in former days (10) Daily alternative to the doctor (2,5) Wise man grows old on displacing a shilling ... . .. (4) To bury little transactions I go and have skin infection (l0) Sweet medicine ... . .. (7) Sounds as though pleasurable therapy was intended ... (9) Therefore on high perhaps for a light diet (4) Fault finder ends with neuralgia (6) Maple provides plenty (5) May be in urinary or gall bladder (5) This fare will increase shock (4) Girl of the vaccine (3)

Four Jorms are available :

OINTMENT OILY SOLUTION SUPPOSITORIES OVULES Attention is drawn to the Oily Solution which is oj considerable help in catheterisation.

Literature available to members oj the Medical and allied proJessions only.

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FIRST AID & NURSI G, MARCH /APRIL 1957

Beaders~

queries

Answered by Dr. A. D. Belilios

R. A. M. (Eastbourne) wrjtes:Having been a regular reader of your journal for some time, and being interested in ),our Readers Queries page, I JVould be grateful if Dr. A. D. Belilios would kindly give me a little information in respect of the pulse. You lI'ill appreciate that the correct taking and timing of the pulse in the present-day competition field is being given greater prominence and this is being used as an aid to the correct diagnosis of the case in hand. I am the trainer and instructor of the section's competition team and I make it a practice to include in the training test pieces the pulse rate, but I am not always sure of the correct rate relative to certain types of injuries, accidents and shock. 1 would be indebted if it is possible to be given some idea of the variation in pulse rates and the volume of the pulse for different injuries to what extent they ascend and, providing the treatment and attention given are correct, to what level does the pulse drop. I would appreciate any other information you may be able to give on this su~ject. I'

Answer A very big question. r advise you to consult books on elementary nursing on this subject. The normal pulse rate itself varies in rate from 60-80 beats per minute- some people say 90. In shock and haemorrhage the rate may go up to 130 or more but note that in nerve shock it may at first be slow, perhaps normal, although the patient's condition is serious. Satisfactory treatment in the 'quick-rate' cases results in a gradual drop to normal. Take the rate at regular intervals and write down the results. In compression of the brain, a progressive drop in the rate confirms the diagnosis and may lead the doctor to recommend an operation. Rates of 70 and less in these cases are suspicious. But every case must be judged on its merits and in conjunction with other signs. pr~sent. Write again if you reqUl:e mformation on a specific questIOn. M. J. M. (Montreal) writes:. I am. always glad to read your znterestl71g replies to the many queries sent you. Perhaps you will be so kind as to an.:Mer this one. In treating a strained muscle, Ivhat e.ffect, or what good is done by applyzng cold compresses if the strain has

just happened, and why hot compresses after an inteITal of time has elapsed. HOlv is the interval of time governed? Answer

Cold reduces the blood supply to the affected part hence may limit bleeding, swelling and bruising. It also reduces pain. Later, hot compresses are applied which improve the blood supply, encourage healing and also, at this stage, relieve pain. W. R. C. (Elstree) writes:At a Divisional practice we assumed that an elderl), man had electrocuted himself, fractured both thighs and had a suspected fracture of the right upper ribs. The patient was found (ving on his back and there was no help available for the first aider. It was generally agreed that the Holger-Nielsen method of artificial respiration should be applied, but it lVas suggested that the Schafer method of turning a patient should be used in preference to the H.N. method to ensure more adequate protection of the thighs. We should be most grateful for your comments on this. Answer

Personally r should prefer the Holger Nielsen method of turning the patient but should expect to see every possible support of the affected limbs undertaken by an assistant during the process. H. J. F. (Royston) writes:-

As a member of the Civil Defence Corps I am trying to make myself efficient at first aid and would be grateful if you would give me your . advice on thefol1owing:.(1) We are told that a casualty wzth a fractured jaw which is bleeding should be placed face downwards on ' the stretcher. What position should he be placed in if he also has a fractured. . . . . (2) The position for a casualty with a fractured spine and a fractured jaw? (3) The position for a casualty with a fractured spine who is unconscious? (4) The position for a casualty with an open wound of the abdomen who is unconscious? . (5) The position for a casualty who IS unconsclOUS and also suffering from a fractured . ... I have asked several first aiders these questions but they seem unable to give me any advice.

Answer' You have omitted vital words in sections 1 and 5 of your question

and as you did not give your address I have been unable to trace you. r can only answer therefore, paragraphs as follows:(2) According to modern methods; the spine would be the priority injury and the patient should be on his back. Should there be extensive jaw damage, turn the head to one side; if blood clots threaten to obstruct breathing, open the mouth and remove them with small mops of cotton wool. Then try and deal with the haemorrhage. Nevertheless personally I would give credit to a first aider who used the face downwards position in an extensive jaw injury where the fractured spine was in the thoracic and lumbar regions. A lot depends on discretion, and the knowledge and experience of the first aider in the face downwards technique-no longer described in the S.J.A.A. manual. (3) r would suggest on his back with the head turned to one side and the usual precautiorls adopted for an unconscious patient. See also above. (4) Again the spine is the priority injury. You will appreciate that your questions are difficult to answer since so much depends upon severity of the relative injuries and the circumstances which prevail. F. R. (Kitchener, Ontario) writes:In treatment for poisoning \l'e are told to use emetics or antidotes as the case calls for. These can 0111y be given if the patient is conscious. Therefore, I would like to knoll' Ivhat a first aider can do if the patient is unconscious and there would be considerable delay before being able to get medical aid or the patient to a hospital.

Answer My warmest greetings to a Canadian first aider, even though your question is a poser. I assume the pois'On is a narcotic. According to the generally agreed principles of first aid, you can only apply the general rules for the treatment of poisoning and for an uncollscious patient at that. Be prepared to give oxygen and do artificial respiration. Smelling salts may be required to stimulate the heart and respiration. A pint of hot coffee given by the rectum as an enema may be of value. A doctor, of course, may be able to give an anbdote by injection.

FIRST AID & NURSING, MARCH/APRIL 1957

BRITISH RED CROSS SOCIETY

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PURCHASE TAX TO BE ADDED TO ABOVE PRICES

E.S.P. TRAINING MODELS Is your Unit equipped with The ESP MINIATURE SKELETON? 26" high, scale model of the human skeleton. Wr:te now for details of this and other valuable traininl aids i ncludine :

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Miscellaneous Advertisements should be sent to First Aid & Nursin" 32 Finsbury Square, london, E.C.l. Rate ~d. per word, minimum 6.. Box numbers Is. extra.

SCENT CARDS. 250 18/6, 1,000 52/6. Tickets, Printed Pencils, Memos. Samples free.-TICES, II Oaklands Grove, London, W.12. S. J. A. B. Badge Wall Shields, 265. 6d. S. J. A. B. Gold cased crested Cuff Links, 50s. S.l .A.B . Badge Ladies' Brooches, 21s., Trophy Shields supplied. Medal ribbons 9d. each on buckram for sewing on uniforms, Is. each ribbon if mounted on pin brooch. Medals mounted. miniatures quoted for. Stamp for leaflets. - Montague: Jeffery, Outfitter I St. Giles Street. Northampton. OUR NEW SERlES of First Aid Competition Papers now ready. Team Tests five for S/-. Individual Tests eight for 5/-. Selby & Plowright, 135 Russell St., Kettering. CLOWNE AMBULANCE COMPETITION. Saturday, June 29th, 1957. Competition for the Chri topher Wright Challenge Cup, open to all England. Prizes for winners and runners-up. Individual competition entries on the day. Entry forms from the Secretary, Mrs. Lovatt, 10 Clune Street, Clowne, Chesterfield, Derbyshire. Entry fee 10/-.

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FIRST A1D & NURSING, MARCH/APRIL 1957

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A Doctor - patient. writing of his own case. makes special mention of the Sanitary Chair. This artie/e. in which he welcomes its introduction. quotes us as the supplie rs.

FOR

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Casualty faking using putty and grease paint has played an important part in First Aid training during recent years. Although very effective, the difficulty is that a considerable amount of time is spent in modelling the wounds and they are ultimately destroyed when treatment and bandaging take place. The new Plastic Wound Replicas are made of soft plastic material which is washable and lasts indefinitely. They can be temporarily attached to the skin with gum and used over and over again. It should be emphasised that the Plastic WOl:lnds are perfect replicas of the wound and cannot be detected from the real thing. The use of these will add zest and a new interest to training, competitions, etc. Full details and sample of Lacerated Wound may be obtained, postage paid, by sending postal order for 3/-.

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BAILLIERE BOOKS FOR FIRST AlDERS A HANDBOOK OF

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With 314 pages and 57 drawings 8s. 6d. Postage 9d.

BAILLIERE'S HANDBOOK OF

FIRST AID AND BANDAGING by Arthur D. Belilios, M.B., B.S., D.P.H., D. K. Mulvany, M.S., M.B., F.R.C.S., F.R.C.P.I., and Katharine F. Armstrong, S.R.N., S.C.M. First aid books, as a rule, confine themselves to injuries, e.g. fractures, wounds, burns, scalds, etc. This volume is far wider in scope. It covers medical conditions of all kinds, and much of the infonnation is not to be found easily elsewhere. There are chapters on case-taking, medical causes of unconsciousness, internal haemorrhage, first aid in maternity cases, first aid in spinal injuries, asphyxia, industrial poisoning, the use of morphme. 'UndoubtedJy the best of its kind.' Nursing Mirror. Fourth Edition. With 488 pages and 200 drawings. 8s. 6d. Postage 9d. Bailliere, Tindall and Cox Ltd. 7-8 Henrietta Street OR London, W.C.2 PI ease sen d me

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FIRST AID & NURSING, MAY/JUNE 1957

MEN'S UNIFORMS and LADIES~ GREAT COATS & COSTUMES for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

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'Grams:

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Nursing Editor: Peter I. Craddock This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.C.2, for the purpose of providing an informative technical service on first aid and nursing. We welcome contributions.

In this Issue Diseases oftheDigestive System

Casualties Union News

Correspondence

Some Topical Medical Notes

Competitions ...

From a Seat in the Audience 10

PATENT

First-Aider's Crossword No. 28 11

First Aid Saves Lives in the African Bush 12

"PORTLAND"

Readers' Queries

AMBULANCE GEAR

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

that •• •

A. Shows the two s tretchers in position. B. Shows the top stretcher lowered ready for loading. C. Illustrates tb e same Gear wIth the top stretcher frame hinged down for use when onlv one stretcher case is carried. . D. Shows t he same position as in .. C .. only with cushions and back rest fitted for conval-escent cases.

Where Ambulances are required to carry four beds cwo Gears are rtted. one on EITHER. SIDE. and the same advantages apply as described above. Full cotoloiue of Ambu lonce Equipment No.7 A will be sent on ~quest.

65, WIGMORE STREET, LONDON, W.I 'Phone I WELbeck 0071

Do you know

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

National Hospital Service Reserve Lecture at Brighton Hospital

IT is one thing to read in the text-books

May/June 1957

UNIFORM CLOTHING AND EQUIPMENT MANUF ACTURERS 154 -164 TOOLEY STREET LONDON BRIDGE S.E.1 'Phone:

First Aid

The population of Newfoundland enjoy complete immunity from hay fever? Chloroform was the first anaesthetic ever to figure in a murder trial? Chalybeate waters (Tunbridge Wells, Strathpeffer, etc.) should be taken hot, as heat assists absorption ? Contrary to general belief, the air is purer at night than in the daytime ? Hydrophobia, as an epidemic, was finally stamped out in Great Britain in 1897? Louis IX, of France, and Pope Innocent ill were mainly responsi ble for the introduction of the voluntary hospital system into Europe from the East?

all about surgical cleanliness and the necessity of destroying or inhibiting the growth ~nd. multiplication of germs, but the apphcatlOn of this knowledge is quite another, and this failure to appreciate its importance is, unfortunately, from time to time demonstrated in the first aid posts and dressing stations, and has been frequently referred to in the columns of First Aid and Nursing. This may have been in the mind of Miss Else, Matron of the Roy al Su ssex County Hospit al, Brighton, when she arranged a lecture on this important subject, to be given by Miss D. F. P. Greenwood, a senior Sister Tutor at the hospital, for the benefit of the members of the N.H.S.R. in the Brighton and Lewes district. The large number who accepted the Matron's invitation fully testified to the appreciation of the importance of the subject by the members, and this in itself must have been very gratifying to her. Having kindly consented to occupy the chair, she introduced the lecturer in a few well-chosen words. Sister Greenwood claimed the attention of her large audience from the beginning by tracing the history of anaesthesia. After describing the early horrors of amputating a limb without anaesthetics, she said that the first attempts to render the patient unconscious were by knocking him on the head, producing concussion, or by the more pleasant method of making him drunk. Passing to the subject of bacteria, the lecturer paid tribute to the work of the seventeenth century Dutchman, Antony van Leeuwenhoek, by his improved methods of grinding and polishing lenses, and he was probably the first man to see those micro-organisms which we now call bacteria. It was, however, Joseph Lister (afterwards Lord Lister) who paved the way to the antiseptic and aseptic methods employed in modern surgery. At first he used strong carbolic acid, but it was quickly discovered that, although this killed the germs, it also damaged the surrounding tissues. The problem was, therefore, to discover some substance which would prevent infection without causing damage to the tissues, as some patients had even died as the result of bums. Briefly the lecturer sketched the life history of the organisms, emphasizing the

rapidity with which many of them could mUltiply. There were, however, two kinds of bacteria, viz .. those which were harmless or even beneficial, and those which caused infection and disease, and were called , pathogenic.' Roughly they could be classified as (a) Protozoa (b) Fungi (c) Bacilli and Cd) Viruses. She wondered ho\', many of her audience realised thal one good sneeze could disseminate 300,000 of these micro-organisms in a room-surely one good reason for using a handkerchief. There were six principal means of ster,ilizing, viz.: ft~ming, burning. dry heat, mOIst heat, cheffilcals and steam, and each was described in detail by the lecturer. In the interval refreshments were sened by sisters and nurses of the hospital, and the Matron herself took and active part in ministering to the gastronomic needs of her guests. The lecture was followed by what could fairly be described as a natural corollary in the form of a number of films illustrating theatre technique. Shots were screened showing the application of the various methods which had been described by Sister Greenwood, and showing the purposes of the many procedures. The films were shown by Mr. G. M. Down, of the well-known firm of Down Bros., surgical instrument manufacturers, late of Borough High Street, but now removed to Church Path, Mitcham. In an interesting chat with Mr. Down afterwards, he informed us that he had been visiting various hospitals throughout the country and taking these films, primarily for the education of his own staff. We feel quite sure, however, that Mr. Down would be willing, time permitting, to show them in the interest of the movement, upon being requested by any responsible organisation, but don't tell him that we suggested this! The Matron then invited the members to ask Miss Greenwood questions, an invitation which was responded to from all parts of the hall. A most interesting and instructive evening was brought to a close by Miss Else, who thanked the lecturer on behalf of the audience, and Mr. Down for so kindly showing the films, and an expression of gratitude to the Matron herself for the interest she had shown in the Brighton and Lewes Branch of the N.H.S.R.

The New B.R.C.S. Monthly WITH the appearance of the fifth number of News Review, which is the new form of the B.R.C.S. periodical, now published monthly instead of quarterly, it can be said to have established itself permanently. Mrs. Peacey, the Editor, with whom we chatted recently upon its production, has good reason to feel proud of her achievement in producing a publication which becomes more interesting with each

nunJber. Moreover, members of the B.R.C.S. to whom we have spoken are unanimous in welcoming a more frequent publication, even if each number is considerably smaller than the . quarterly', which it has superseded. It Will serve to keep its members right up-t.o-date resp~t ing the activities of the Society. We WIsh Mrs. Peacey and [he News Rel'ielV eyery Sllccess.

FIRST AID & NURSING, MAY/JUNE 1957

A Course in Elementary Medicine

Diseases of the Digestive System

THE last article in this series was

concluded by giving a brief description of the liver together with one of the common ailments associated with this organ, namely jaundice. There are of course many other diseases which affect the liver but they are not common or of great interest to the general reader. Conditions of the gall bladder, however, must be described. Cholecystitis This long word means inflammation of the gall bladder. It may be an acute or chronic ailment. The acute variety is due to an infection with germs and is often associated with the presence of gall stones. The patient complains of severe pain in the upper part of the right side of his abdomen which is very tender to the touch. The tongue is furred, the temperature of the body raised and the pulse fast; other symptoms and signs of fever may be present. .In. mild cases, recovery takes place wlthm a few days but sometimes pus forms within the gall bladder or its walls become gangrenous in which event the patient may become seriously ill and his condition necessitate an operation. Chronic cholecystitis is a common cause of chronic indigestion and takes the form of irregular pain in the upper part of the abdomen flatulence, nausea and sometime~ h~adaches. The complaint may be dlfficult to diagnose since it may resemble other ailments such as a peptic ulcer or chronic appendicitis. Help can be obtained by an X-ray of the gall bladder. A drug com!ll0~ly known as ' gall bladder dye' IS glven to the patient on the evening before. the examination. By the followmg day, this dye which has been absorbed reaches the gall bladder through the bile and when photographs are taken the organ,

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

if healthy, shows up as a pear-shaped shadow; if this shadow cannot be seen or appears irregular or deformed in its outLne, conclusions are drawn as to the unhealthiness of the gall bladder. Gall Stones These form in gall bladders which are unhealthy. Sometimes there is only one big stone but frequently a large number are found. The ailment is much more common 111 women than in men. So long as the stones remain in the gall bladder, they may cause no symptoms or only those of dyspepsia due to chron~c ,holecystitis. But if a stone leaves the organ and attempts to pass down the various ducts which lead towards the duodenum an attack of intense pain called biLary coLc occurs. The excruciating pain is situated in the' pit of the stomach' (epigastrium) chiefly on the right side; it may also be felt in the region of the right shoulder blade and shoulder; shivering, sweating and vomiting may occur. The pulse is generally slow and the temperature subnormal. A small stone may pass down the bile duct and enter the duodenum. Sometimes, however, after an attack ?f varying length, it may slip back mto the gall bladder. A serious complication is that the stone may become stuck in one of the ducts giving rise to an acute cholecystitis or to jaundice. If the stone becomes lodged at the end of the common bile duct just before it enters the duodenum, the patient may develop a group of symptoms known as hepatic intermittent fever. He is liable to attacks of rigors (severe shiveri~g) together with vomiting and a Tlse of temperature. There is usually colic and jaundice may follow. Usually the only effective treatment for gall stones is an operation

for removal of the gall bladder and the stones which it contains. Cirrhosis of the Liver In this complaint, there is hardening of the liver due to increasing formation of fibrous tissue which impairs the activity and function of the organ. There are several distinct varieties, given different techIDcal names; only one will be described in this article-the one which is the most common and known to the public as cirrhosis of the liver. There is considerable doubt as to the causes of the complaint although it is generally assumed to be due to the action of toxins which reach the organ through the blood stream. In many cases, excessive indulgence in alcohol plays a part; at one time the ailment was called ' gin-drinkers liver. ' The disease develops gradually, the organ often becoming enlarged, hardened and its surface which is normally smooth, irregular with numerous projections arising from it; in the later stages, however, the organ may tend to shrink. Symptoms are variable, there is usually indigestion which takes the form of loss of appetite, a furred tongue, and sickness particularly in the mornings. The abdomen often becomes enlarged, this being due to fluid. Recurrent attacks of haematemesis may occur. ~s the disease progresses , the patient becomes thin and weak and jaundice develops. The complaint may be fatal but treatment can produce an improvement and life maintained for some years. Peritonitis Inflammation of the peritoneum ha~ been mentioned in a previous artIcle namely that on peptic ulcers. It consists of inflammation of the inside lining of the abdomen and can be due to many causes. It may for

FIRST AID & NURSING, MAY/JUNE 1957

example, result from injury, e.g. a wound of the abdominal wall which penetrates the abdominal cavity will allow germs to enter setting up the complaint. The perforation of any organ such as the stomach, duodenum or appendix, is a well known cause while sometimes the germ is brought to the peritoneum by the blood stream; the pneumonia germ can set up peritonitis in this manner. The symptoms and signs of general peritonitis were described in the January/February article hence there is no need to repeat them again. It should, however, be realised that not all cases of peritonitis are acute, there are chronic varieties of which the most important is tuberculous in origin. It occurs most commonly in children and young adults and is associated with general weakness and loss of weight, discomfort, tenderness and pain in the abdomen which frequently becomes distended. The disease runs a prolonged course but treatment is generally successful. Hernia Though not strictly speaking a medical as opposed to a surgical ailment, the subject of hernia or rupture can be conveniently considered in this article. It results from a weakness in the wall of the abdomen for example a gap in the muscles which allows some of the contents of the abdomen-fat or intestines-to come through and form a soft swelling under the skin. It is generally found in the groin but it may occur in any part of the abdomen when it is called a ventral hernia. A hernia may cause discomfort or even a ' dragging ' pain. This, however, is very variable and in any case usually ceases when the patient lies down with his muscles relaxed. The swelling itself generally disappears when the patient is in the recumbent position. A hernia may be due to many causes. The weakness in the abdominal wall may date from birth or develop gradually as a result of a recurrent cough, repeatedly lifting heavy weights or other cause which throws a strain on the muscles. A complete cure can be effected by an operation or the condition can be controlled by supplying a support known as a truss.

A serious complication of a hernia is strangulation which may occur when the blood supply of the contents of the intestines or fat is obstructed. This may occur from an extra strain such as coughing or lifting in a patient who already has a hernia.

Severe pain is experienced in the swelling which soon becomes firm, tender and larger in size. At the same time the patient suffers from shock and this is followed by the symptoms and signs of acute intestinal obstruction. An urgent operation is necessary to save life.

~asDalties Union News News from the Branches IT seems to have been the busy month of May for most branches, and a varied assortment of work has been done by one and all. Altrincham Have been extremely busy with the provicting of casualties for the Scouts, R .A.M.C. and various competitions. Casualtics Union figured in the Saturday programme of the Urmston and District Boy Scouts Association, Jubilee Camp on 11th/12th May, when they provided five casualties for five teams of first aiders. Also on 1ltb/12th May they provided the casualties for M C Volunteer Medical Staff Corps (T.A.) Challenge Shield team tests. Saturday's tests involved a crushed foot caused by a 3-ton service lorry, and a fractured wrist due to a fall from a ladder. The incident was an aU military one, including language from some of the teams who had previously only dealt with , luggage label' type casualties. Sunday's test was much more complicated, being held under actual battle conditions with an almost identical terrain as that of a battlefield in Italy during the 1939-45 war. It was held in a natural park north of Manchester, thickly wooded with a natural steep ravine, and due to a terrific thunderstorm developed into a quagmire. The casualties who were issued with proper uniform and full kit, and special identity discs were in duplicate as it took the stretcher bearers about three quarters of an hour to rescue the casualty and transfer him to a casualty clearing station via the command and first aid post. The actual trek was through the most difficult part of the terrain and through a 'clear' path of a minefield. We take our hats off to the two members of Altrincham Branch for being tiptop casualties who submitted themselves to real danger, as they were lashed to the stretchers with manifold harness, and nothing could have saved them from real injury, had the stretcher bearers slipped during the tests. The injuries inflicted by a mortar bomb and rifle fire, were a mortar bomb wound of the abdomen, small flesh wound, fractured mandible with intra-oral haemorrhage.

Norton Branch On May 5th Norton Branch held their second annual training day, which was most successful. Branches taking part were Newcastle, Altrincham, Halifax and Hull and members of two Study Circles orton Branch were from Scarborough . the hosts for the day. The afternoon demonstrations for the local first aid groups were varied and instructive, and included displays of special injuries, staging of casualties, nursing, fractures and instructor and probationer examination tests. A very good day's training was enjoyed by all Casualties Union members attending. The training was held at the Yorkshire Farmers' Bacon Factory (by kind permission of D. M. Thompson, Esq.). Belgium Circle It is a pleasure to report the success of the first of our non-English speaking S C to complete the course. In just over five months our Circle in Belgium (Bruges) has overcome aU the difficulties of language interpretation, securing of make-up materials and postal delays, and has introduced the technique of Casualties Union to the Civil Defence of Belgium. In offering full membership of the Union to the probationers of the Circle, we have taken another important step towards the international status of Casualties Union.

CASUALTIES ~ON DAY Will be held this year at the London University Sports Ground, Motspur Park, Surrey, on Sunday, 6th October, ]957.

Confessions of a Competition Casualty HavillK been a first aider for years alld now a member of Casltalties Ullion I have discovered that:Seaweed tastes awflll when the first aider forgets to look in the moltth before COIllmencing artificial respiration. How good it is to be treated kindly and serial/sly by an earnest first aid team. It is a good thing that the real epileptic is unable to feel the rough handlillg al/d hear the remarks made by the first aider durillg his/it. , . How milch it hurts to have one s feet tIed together, without a pad betweell the ankles.

FIRST AID & NURSING, MAY /JUNE 1957

COrrl!SlJO"dp"c~ Letters to our Technical Editor, F. C. Reeve The Future of the Team Test Dear Sir, I read with great interest the article' The Future of the Team Test,' by F. C. Reeve, just as 1 read his articles' From a Seat in the Audience.' I am sure that if more competing teams read his comments the standard of competitive first aid would rise even higher than it is. I am, however, evading the reason for writing to your journal. I have a ' bee in my bonnet' about competitions, not that I am a competition first aider. With the growth of first aid competitions, I think that it is time that the organisations responsible for first aid training got together and set up a governing body, with the task of setting up a charter on first aid competitions. With the publication of the new textbook on first aid, due for release in the next few months, they have a good start for I understand that the B.R.C.S., S1. A.A.A., St. J .A.A., and C.D. have all cooperated in the standardising of this manual. Why not now draw up a set of rules for governing all first aid competitions, nationally and locally? One still sees juveniles being given oral questions which have been taken from the First Aid Manual , and not from the Preliminary First Aid Manual, which is not fair to the competitors. The standard of faking casualties which I have seen has been very high, but this varies according to the technique of the faker. For the teams which have been trained with the new plastic models, the technique of plasticine and putty, and other methods is a little confusing. They expect one thing and find another. I quite appreciate that the first aider should adapt himself to the conditions and the faking. If a standard was set though, for aU competitions by the use of standard models it would ensure that all had the same chance (may 1 point out that I have no interests in the makers of these models!) T can say that at a recent Hobbies exhibition where they were displayed they aroused considerable interest in the members of the public. I do expect that there will be an outcry from the members of the first aid community who have devoted so much time to training of faking. They would still be needed though, to make up the faces of casualties and adding the additional trimmings to the plastic replicas, which cannot be reproduced in plastic. T shall be very interested in hearing the comments of Mr. Reeve, who I think is one of the best critics of the competition world. Yours sincerely, THos. H. HOLLINGWORTH Sergeant, Newark Amhulance Division: Mr. Reeve's reply: I ,!-m in complete agreement with Sergt. I,I0lhngworth respecting the standardisatIOn of competition tests for it would avoid man~ anomalies. Two years ago I was coverlOg the Dock Labour Board finals at Toynbee Hall, and was standing

with Dr. Lancelot Wills (who did not happen to be judging that day) watching one of the dual tests, which included a fractured clavicle. To our amazement we saw a pair using the St. John sling with pad and body bandage, which had been abandoned by St. John since the publication of the 40th edition in 1950. I spoke to the judge afterwards about this, and he explained that it was a Scottish team that he had been judging, and he had been instructed to judge all the Scottish teams on the St. Andrews' text-book, which still retained the older method. This, however, is by no means the only example which 1 have experienced in major competitions in which methods have been employed from different text-books. One crack team which has competed more than once in tbe Grand Prior is a B.R.C.S. trained team, yet for this purpose they have to know St. John as well. The standardisation of the new textbooks is a step in the right direction. Three years ago I discussed this possibility with both Air Commodore Hewat, Medical Adviser, B.R.C.S. and Major White Knox, Principal Medical Officer, S.J.A.A., but, whilst both admitted that there would be many advantages, there appeared to be at that time many difficulties. I am certainly very pleased that these difficulties have now been overcome. The cases, mentioned by Sergt. Hollingworth, of juveniles being set questions from the senior text-books are, fortunately rare, but when they do occur I am afraid that the fault must lie with the judges, who have not made a sufficient study of each text-book to enable them to differentiate. With regard to the new plastic models for , faking' there is, I know, some diversity of opinion, but Sergt. Hollingworth will find that classes are not being' trained with plastic models.' They are still being trained with plasticine, putty, etc., and are using the plastic models as alternatives when the use of the original technique is, for some reason, difficult or impossible. Good as many of these models are, they possess severe limitations. Dear Sir, The Future of the Team Test I intended to write to you after your excellent article on this subject in the March /April issue of First Aid & Nursing last year, but unfortunately did not do so, and now with the current issue's inclusion of your further contribution I have been prompted to send you some of my own personal comments. Firstly, may I be permitted to congratulate you on the clarity with which you have dealt with this age-old problem of team tests. Thank you for putting into cold print the true facts which so many of our contemporaries in competition work have been trying to brush aside for so long, but now have to recognise. As a. ~ompetitor in many local brigade competitions and an assistant in the organisation of others, under the auspices of Croydon Centre S.J.A.A., I have for a long time shared your v iew that however good the tea~ and the test may be, in its present form It does not achieve precisely what all competition work shouldnamely the raising of first aid standards among all who take part. Admittedly,

the team must work as a real team in the best sense of the word but it does seem to me that far too much emphasis is placed on the team leader who has, however good (or bad!) he may be, to be the 'mouthpiece' in making the final diagnosis. As No.4 ill a team recently, I found after doing the 'fetching and carrying' (necessary as it is) that the test had almost been completed before I personally even had a chance to see the patient-already surrounded by the rest of the team-let alone find out what precisely were his injuries!! I am not disputing the detailed pros and cons of this case but merely quote it to stress what 1 believe is a valid point in arguing for a change such as you have recently so wisely advocated. Another point worthy of mention (in support of the 'several patients' theme) can be found in all analysis of dual and team test mark sheets which often reveal a higher score by Nos. 2 (or 3) and 4 than perhaps No. I and his colleague. If you are interested I could supply details, but I feel sure you readily appreciate what I am driving at, having doubtless met the same thing on numerous occasions yourself. These views are of course purely personal but you may (for what it's worth) quote my comments as freely as you wish. Once again my grateful thanks for all your splendid efforts in the cause of increased first aid efficiency-together with apologies for burdening you with a further letter in your hea vy postbag. Yours sincerely, ERNEST B. HAMLEY. Croydon, Surrey. (No. 99, Lambeth, Ambulance Division) Mr. Reeve's reply: With reference to your remarks upon the influence of competitions upon the standard of efficiency throughout the whole movement, you may be interested to learn that, in one case at least, to my knowledge, the value of the team members in this respect has been recognised by a detachment (B.R.C.S.) promoting the leader to the rank of Assistant Commandant and two other members of the team to be Quartermasters. In a recent conversation with the Commandant of this detachment she informed me that these members of th~ team- a well-known crack team-had proved most valuable in their lJew positions as officers. Dear Sir, From a Seat in the Audience I was very interested to see in your ~andom comments an item concerning Judges. As a team coach I was disturbed last year at one of the finals at Central Hall to learn that the judge himself actually gave the card for 1 and 4 to bearers 2 and 3 as they arrived for their test. (He had accidentally picked up the wrong card.) The Nos. 1 and 4 of the team had completed their test, a fact known by Nos. 2 and 3 who were surprised to get the same card. They did not raise any comment as they assumed that on Iy one test was being set for the two pairs (which has happened). Due to their misleading briefing they were· puzzled as they worked through the tes~ and failed to discover a small injury for whIch 10 marks were allowed for its diagnosis and treatment. The team came second, losing by 2t marks to the winners!

FIRST AID & NURSING, MAY/JUNE 1957 You can imagine their feelings. but they agreed to accept the' judge's decision as final' in a true sporti ng spirit. I suggest that the card should not be handled by judges but by a steward, whose brain does not have to think of as many details as a judge and is therefore less liable to make a mistake. The competition rules for the judges should contain such a clause. Judges should confine their activities to judging! Yours sincerely, C. A. LlFFoRD, Peri vale, Greenford, Middlesex.

Mr. Reeve's reply: Yes, I well remember the incident at the Central Hall last year to which you refer, and, although I did not discuss it with the judge afterwards, knowing the judge as I do I am quite certain that no-one was more distressed at the unfortunate occurrence than he. We must bear in mind that, however fool-proof a system may be thought to be, allowance has always to be made for the human element. Nothing could be done in the circumstances short of commencing the competition all over again

with a new set of tests, which, of course, would have been impossible, and the matter had to rest there. In most major competitions the cards are handled by the judges' stewards, the competitors passing straight to them from the custody of the security stewards. I feel quite certain that it will never happen again . Incidentally, let me hasten to assure you that this was not the incident I had in mind when writing the 'comment' to which you refer. Tn fact , my comment was rather a generalization.

Soml! Topical Ml!dical Notl!S By F. C. Reeve, F.Z.S., F.R.E.S., F.I.C.A.P. FOLLOWTNG the close of a recent criminal trial ' which has aroused world-wide interest- incidentally, the accused was found' not guilty '-and which will, doubtless, become a classic, I have been inundated with so many requests for information relating to certain clinical conditions and the actions of certain drugs mentioned during the hearing of the case that I have decided to answer, at least, some of the questions through the columns of Firs! Aid & Nursing, as being of general and topical interest to our readers. No attempt is made to comment upon the case itself, the article being confined to an explanation of certain medical terms introduced during the hearing of the case. Very early in the case. reference was made to a ' stroke,' and thiS has prompted quite a large number of questions . • Stroke' is a vague term, used very loosely by the layman, but is generally intended to ind icate a sudden loss of consciousness, with prostration, resulting from pressure on some part of the brain. The correct description of this condition would be , apoplexy,' first used by Hippocrates, and follows the rupture of a blood vessel within this organ, the escaping blood forming a clot and thus setting up pressure. AJthough there are several types of apoplexy, by far the most common is that caused by hardening of the arterial walls in elderly people, which deprives them of their elasticity and power to resist the normal systolic pressure, under which the wall gives way. This term, apoplexy, should present little difficulty to most first aiders as lecturers usually go out of their way to explain this condition fully. The next question, and the explanation, also bears directly upon this subject. The clinical condition which received most consideration during the case was that of ' cerebral arteriosclerosis,' and it is this term which has prompted by far the largest number of questions. , Arteriosclerosis' is the term applied to this hardening of the arterial walls just referred to, and is due to a general increase in the fibrous elements of which the artery walls are composed. At the same time the muscnlar and elastic coats of the walls undergo a hypertrophic change, that. is, they increase in thickness, this belOg nature's method of compensating for the heavier work which they have been called

upon to do as a result, often, of higher blood-pressure. In the case of the minute arteries of the brain, owing to the increase in thickness of the inner coat, the lumen, or internal diameter of the vessel, becomes smaller, thus increasing still further the pressure on the walls at every systole. It was this 'cerebral arteriosclerosis' which was mentioned several times during the case, and which appears to have puzzled so many of my questioners. Another predisposing cause of apoplexy is 'cerebral thrombosis,' also mentioned during the case, (lnd which I have been asked to explain . Thrombosis is sometimes described as a blood-clot witrun a blood-vessel- artery, vein or capillarybut as the formation is not identical with the process of coagulation as we know it, perhaps it would be more accurate to describe it as a solid or semi-solid mass formed from the constituents of the blood. A thrombus- for that is the name given to this solid mass- may form in any part of the vascular system, and in any type of blood-vessel. There are various kinds of thrombus, and they may be classified in different ways, but when classified according to the vessel in which they are formed they are- described as arterial, venous or capillary. A thrombus, therefore, forming in one of the smaller blood-vessels of the brain - cerebral thrombosis - can cause congestion in the vessel, leading to its rupture, resulting in apoplexy. A term, mentioned only once during the trial, which has perplexed a number of ~y enquirers, is 'thalamic syndrome.' FIrst of all it should be explained that a syndrome is a group of symptoms which occur in combination, and are recognised as indicating a definite clinical condition. Perhaps the best example of a syndrome that 1 can offer to our nurses is that of the Stokes-Adams syndrome, which consists of an abnormally slow pulse (bradycardia), periods of gid~iness, or even unconsciousness, convulSive movements or twitching of the face and arms, pallor alternating with cyanosis and stertorous breathing a combination usually indicative of heart-block. This condition yOLl will frequcntly come across in the medical wards. The' thalamic svndrome' is usually the result of a lesion of the thalamus, a mass of grey matter at the base of the brain, and

exhibits the following combination of symptoms: loss of the sense of touch all down the side opposite to the lesion, spontaneous pains on the affected side of the body and irregularity and lack of muscular co-ordination, also down one side. DRUGS Questiom; were also asked concerning a number of drugs mentioned during the hearing, but the one which was mentioned more often than any other was morphine. This, together with several of the others, which were more or less proprietories, is a derivative from opium, and although they may differ from one another slightly in their detailed action, their general action is the same. These detailed differences, however, are important only to the medical man and need not concern my readers. Some general observations, therefore, on opium and its action will, I trust, prove interesting, and will serve to answer most of tbe questions which have been put to me. Opium is obtained from the nearly ripe dried capsules of the white poppy (Papaver somniferurn), which is grown chiefly in India, although China, Iran and Turkey all make valuable contributions, and it is now largely cultivated in this coun~ry. Of ,its many alkaloids perhaps morphme, codeme and thebaine are the best known. Speaking generally, the action of opium is almost exclusively on the central nervous system, and in mammals, particularly on the brain. The physiological action of opiUII? and its alkaloids varies considerably, beIng governed by many factors.. I~deed, so:n e scientists have spent a llfetlme studymg this subject alone. Here we will rest content to recognise that it varies with the dose and we will divide this into three stag~s. A small dose, say, from t gr. to 1 gr., is followed immediately by a stimulation of the mental powers. The pulse is rapid and full and the patient appears to take a much livelier interest in his surroundings. The length of this stage varies, bl!-t it eventually passes off and the patIent gradually develops languor and fa 1.1 s asleep. Medium doses (1 gr. to 2 gr.) still produce an initial stimulating effect, bu~ of much shorter duration, and the patIent falls into a deep sleep, although, curiously enough, he can be easily aroused .. It h~s been found by experiment that dun~g thiS sleep the brain is anaemic, both a:tenes. and veins being aln10st ~mpty. FlfSt-Alders

FIRST AID & NURSING, MAY/JUNE 1957

6 should note that it is doses of this quantity and upwards that produce the pin-point pupils referred to in your tex~-books. 3 gr. or more may be regarded as pOisonous, or toxic doses, and in these cases the initial st~ge of excitement is very short, the patient passing immediately into a state of coma, followed in a very short space ?f time by death. It should be noted In passing that shortly bef?re death occ~rs the pupils, formerly pm-pomt, become. dilated. Opium, together with its alkalOJds, has beeT). described as the most valuable medicine ever discovered. Besides its value as an analgesic, which is well-known, it also possesses valuable properties when

apphed externally. As laudanum it is llsed in fomentations for easing painful surfaces, such as those produced by lumbago and pleurisy, and is also used as 'drops' for earache and toothache. Codeine, known so well to patients attending casualty, is also an opiate, but its hypnotic action is only slight. It is prescribed in many cases where sleep is interrupted by pain. Atropine, which was mentioned once or twice during the trial, is an antidote to opium, and is often introduced during a course of morphine for the purpose of counteracting the poisonous effects of the opiates.

I have not mentioned heroin (Diamorphine hydrochloride) specifically, although it was referred to many times during the case in question, because, being a morphine derivative, the general notes on opium appearing above will also cover this drug. Luminal, which I believe, was mentioned only once, is a barbiturate and is a more powerful hypnotic than barbital, requiring more care in its administration than the latter. It was my intention to conclude with some remarks upon tolerance and addiction, but this is a vast subject, and had better be reserved for a specia l article at some future time.

Competitiol'S London Transport Finals Challenge and Probyn Shields and Norman Cup THE Borough Polytechnic was the venue this year for this important event, and, as usual, attracted a large audience. Ten teams took part, each representing one of the ten London Districts covered by London Transport, and each had to submjt to a team test and oral and dual practical tests. The practical tests were as follows: Team Test, set and judged by Dr. D. D. Towle, of Blackheath: The team is called to deal with a man who has fallen through the glass roof of a joinery works on to a circular saw. Injuries: Large lacerated wound in left side, fractures of right ulna and humerus, bitten tongue, bruised hip. He loses consciousness later in the test. Dual Practical Tests, set and judged by Drs. G. M. Shaw Smith, of Tottenham, and J. C. Graham, of Highgate: Nos. 1 and 3 see a man with blood streaming from his hand. Injuries: Large gash in forearm, contusion on forehead, sprained ankle. Nos. 2 and 4 see a man attacked upon leaving a bank. Injuries: Slight concussion, bruise on forehead, simple fracture of right tibia, cut left wrist. Mr. Alex J. Webb, Chairman of London Transport Ambulance Centre, occupied the chair, and introducing Mr. C. E. Dunton, Chief Civil Engineer of London Transport, who was to present the trophies, remarked that it had been another good contest. He asked the judges to deliver their comments on the tests, and Dr. Towle led the way. He admitted quite frankly that the team test had been a difficult one, and he had been amazed that the teams should have tackled it so well. There were, he said, two types of first aid, viz. first aid for examination and first aid for competition. They (the judges) were ]10W making the tests a little more difficult because of the improvement in the teachings of first aid. Jt ,,"ould probably have been noted that he had separated the leader from the rest of the team. He had done this deliberately. . You MUST read the card-all of it,' he emphasi ed. He also reminded them that they must never leave a patient in a position of danger. The patient must be removed from further

danger, whatever may be his injuries. When they found that the patient had been cut right through the chest wall, what were the possibilities? Haemorrhage for certain. There would, also be the possibility of fractured ribs, with consequent injury to the lungs. The bleeding from the mouth had misled some, as it had been intended to do, and more than one had missed the fracture at the elbow. He advised them, as a general rule, to carry out any immediate treatment obviously needed, then check up. When a patient passes out, it is most necessary to try to discover the cause. • Don't sit a heavy man on a chair if he is unconscious,' said Dr. Towle, 'He'll roll off.' In bandaging fractured ribs the patient must be instructed to breathe out if the maximum of support is to be obtained. It is unnecessary to take an ordinary faint to the hospital, and DO 'T kick the handles of the stretcher in. Dr. Graham said, ' It is the practice to ask us judges to comment upon the competitors, but today I overheard some competitors commenting upon ME.' (Laughter). Dr. Graham did not disclose the nature of the comments! He went on to offer some very useful criticisms. Some did not fully expose the wound whilst others failed to apply a large enough dressing. Referring to the oral tests, some had not displayed a thorough knowledge of the treatment of carbolic acid poisoning. On the whole, however, he had been pleased to see so many good teams comlng up. Reverting to the practical tests, he recalled that one or two teams had left the patient lying half on the pavement and half on the road-a very uncomfortable position. He had intentionally provided no blankets as the finding of these was, in many cases, automatic. The stewards had performed a very useful service in re-winding the roller bandages, but he would like to have seen them tighter, in the interests of the competitors. He was afraid that some of the competitors had had a somewhat unhappy time passing their oral tests which had, he admitted, been difficult, and once or twice he admitted that he had wondered if he had been entirely fair. It must be borne in mind, however, that this competition was on a very high level. Dr. Graham concluded by thanking everybody for their co-operation. .

At this point the results were announced: l. Chiswick ... 417 (winning the Challenge Shield) 2. Manor House' A' 405t (winning the Norman Cup) 3. New Cross 'A' 397 4. Reigate (women) 383 (winning the Probyn Shield) 5. Peckham 'A' 377k 6. Dorking ... 376 7. Rornford 'A' 365t 8. Chiswick (women) ... 1 tied 358 8. Clapham ... f 10. Lots Road 354 Mr. Garwood thanked the judges for once again giving their services to this great cause, for these competitions would not be possible without their valuable help. • We thrive on their criticisms,' he said, • which are always followed by improvements.' Before presenting the trophies, Mr. Dunton thanked them for asking him, for he regarded this interesting duty as a great privilege. That day had been an eyeopener. The tests had been difficult, but they had been well carried out. He praised the voluntary spirit which pervaded the whole movement. One volunteer, he said, was worth ten pressed men, and he referred particularly to Mr. Scofield, who had been in charge of the making-up of the patients. In thanking Mr. Dunton for presenting the trophies, Dr. Norman, Chief Medical Officer and Vice-President of the Centre, said that they had a great deal to be grateful to Mr. Dunton and his lady for, and he felt sure that they would all benefit from his encouraging remarks that day. Would it surprise his audience to learn that over 20,000 cases had been treated during the year by first aid members of the staff? Thc Chairman said that the success of these events was due to the hard work of Mr. Harden, their Centre Secretary, and they always liked him to wind up. Accepting this invitation, Mr. Harden said this was the final event for the year, the ten teams they had seen that day being the survivors of 70 teams which had competed in the preliminaries. . Without the teams I can do nothing,' he sa id. He wished to

FIRST AID & NURSING, MAY/JUNE 1957 thank the officers and officials for the support they had always given him. He was indebted to the various secretaries, the stewards and other helpers, the ladies who had served the refreshments, and especiaJJy to Mr. Best, who had been, once again, responsible for the scenery. 'Good luck,' he concluded, • to these winners, who will now go forward to the national finals.'

Metropolitan Women Police 'Lady Abbiss' Competition

IN first aid women are becoming more and

more competition-mjnded, and in the forefront of this advance are, undoubtedly, the ladies of the Metropolitan Police. The final for the' Lady Abbiss' Trophy, now recognised as a major event, was beld again this year at the 'Percy Laurie' House, that magnificent section house at Putney, and the tests were watched by a large and enthusiastic audience. Team Test, set and judged by Area Surgeon R. L. MacQueen, M.R.C.S., L.R.C.P.: A maid, scrubbing the steps, bas heen stung by a bee, which causes her to lose her balance, falling down tbe steps. The team is asked to render help. Injuries: Bee sting on right knee, fractured base with compression, compound fracture of left forearm. Dual Test, set and judged by Area Surgeon G. E. B. Payne, M.D., D.P.H.: A man, hanging a picture, has f'.lllen from a pair of steps. The two competitors are called upon to assi'>t. Injuries: lncised wound ofright forearm, fractured ribs on left side, internal haemorrhage, haemorrhagic shock develops .. Occupying the chair at the presentation ceremony was Miss E. C. Bather, O.I~ E . (Chief Superintendent, Metropolitan Women Police), and she was supported ~y Sir John Nott-Bower, c.V.O. (Commissioner Metropolitan Police), Capt. Rymer Jones,' O.B.E., M.C. (Assistant Commissioner, Metropolita~ Police), Inspector Williamson, Surt. MISS Yates and the judges. . In extending a welcome to Sir John ott-Bower, who had kindly consented to present the tropby, she expressed the tremendous pleasure they all felt at the honour he had done them that day. She also wished to thank Capt. Rymer Jones for his continued support. Whilst the marks were being totalled he felt that she could not do better than ask the iudges to deliver their con1<'11ents , and she invited Dr. MacQueen to open thc ball. Dr. MacQueen, in congratulating the teams upon the high standa~d of w<?rk he had seen that day, said that it was dIfficult to find anything to criticise. One or t.wo small point, however, had occurred to h!m. No-one had thought to kill the bee! Some of the teams had been perplexed because they had been unable .to discover any external signs of compreSSIOn, but he reminded them of the bloodsh?t eye. Referring to the head injury" he s~id there is now a tendency to discontInue t ~e application of cold compress .. for thiS purpose, although for compet.ltl~n purposes they must stick to the eXistIng te.xtbook. Some had lost marks for elevatwg

the limb before discovering the fracture. More use could have been made of the two men standing idly by. On the whole, however, the work had been excellent. Dr. Payne followed, but admitted that, like Dr. MacQueen, he had not many criticisms to offer. He did point out, however, that if some of the teams had read the card more carefully they would have been saved considerable trouble. In most cases where marks had been lost they had been for omissions rather than commissions. It would be seen when the results we{e announced that the marks were so close that the judging had been a most difficult task. Following the judges' comments the results were announced: l. No. I District 'A'

331}

(winning tbe • Lady Abbiss' Trophy) 2. No.4 District 'B' 3. No.3 District 'A' 4. No.1 District'B' 5. No.2 District 6. NO.4 District 'A' 7. NO.3 District 'B'

327 319t 308±305i 300i

329~

Miss Bather then invited Sir John to present the trophy. Before doing so, he said he would like to say how pleased he was to be with them. He regretted that he had onJy been able to see the last team at work, but from what he had seen and heard he believed, with the judges, that the standard had been very high. He commented upon the team test, and said that he thought it must have been almost worth while being stung by a bee to be fussed over by four ladies as the patient had been! He was proud of the first aid development which had taken place during the past few years amongst the women police, due very largely to the work of the First Aid Committee under their chairman, Supt. Yates. It was very encouraging to see so many of the younger women police taking so keen an interest in this very valuable subject. The Commissioner concluded by paying a well-deserved tribute to the doctors who bad kindly consented to judge the competition. A local photograph from the North-of the British Railways N. E. Regi.on Ambulance Competition Final. The group shows, back row: Members and Secretary of the successful team, Newcastle Central. Front row : Dr. R. Fraser Mackenzie, Mr. C. Cooper, Mrs. Short, Sir Mark and Lady Hodgson.

Miss Bather thanked Sir John, on behalf of all those present, for so kindly consenting to present the trophy, and referred to the keen interest he had always sho\.yn in their work, although his many pressing duties prevented him from attending these events as often as he ",ould wish. There were many others she would like to thank, although it would be impossible to enumerate tbem all. Of the~e, she specially mentioned Inspector Williamson, whose experience in these matters had proved so valuable to them, the stewards and the patients. The judges they could never thank sufficiently. They were also most grateful for the use of that splenclid Section House, and she concluded by adding her thanks to those of Sir John for the valuable work of the First Aid Committee, who had also been responsible for the refreshments. The presentation to Miss Bather of a beautiful bouquet proved a most pleasing climax.

, Gracie Lucas' Competition IT may not be generally known that there are three police forces operating in London, the Metropolitan, City and British Transport Commission, and an example of the fraternal spirit existing between them i') the Annual Event, part social and part first aid competition, held by the women's sections of the three forces. Each force takes it in turn to entertain the other two and this year it was tbe tum of the Metropolitan Women Police. It was held at the' Percy Laurie' House, Putney, and proved a most enjoyable event. The competition for the • Gracie Lucas' Trophy. presented by Mrs. Lucas, the wife of Chief Superintendent Luc~s, who. has. recently retired from the City Police, 1S always keenly contested, and has come to. be regarded as one of the maj.or compet!t!ons of the vear. As in most major competltlOns it con-sisted of a team test and a dual practical test. Team Test, set and judged by Major E. W. Tapley, M.R.C.S., LR.C.P ..: The team is met by a boy, rushmg for the doctor, who informs them that his brother

8 has met with an accident in the house. He appears to have fallen from a ladder whilst hanging a picture. Injuries: Wound of right calf, severe haemorrhage and glass embedded, small lacerated wound, right palm, slight haemorrhage, simple fracture, right humerus (upper third), simple fracture, left fibula (lower third), fainting and nerve shock. Dual Practical Test, set and judged by J. H. Chambers, Esq., M.B., C.H.B., D.I.P.: Injuries: Minor laceration, right side of forehead, simple fracture, right leg, concussion-patient unconscious. The gathering in the large hall to witness the presentation was an interesting one, consisting of a mixture of all three uniforms, Metropolitan, City and B.T.C. Women Police, and it was presided over by Miss E. C. Bather, O.B.E., Chief Superintendent of Metropolitan Women Police, who was supported by Mrs. Lucas, Mrs. Simpson, Chief Superintendent J. Goyder (City), Col. Jesper (B.T.C.), Capt. Rymer Jones (Met.), Superintendent Miss Yates and the judges. Other interested personalities we noted in the hall were Col. Young, Chief Superintendents Shannon and Way, Chief of Police, Beynon, Superintendents Moody, Crane and Hemmings. Also present as interested spectators were two recently recruited women police officers from Trinidad, who were spending six months in London on a training course. Miss Bather said that it gave her very great pleasure to welcome, on behalf of the Metropolitan Women Police, their colleagues from the other two great London forces. As a matter of fact, there were really four forces represented there that day, as they were welcoming representatives (referred to above) from Trinidad. They were honoured, also by the presence of Mrs. Simpson and Col. Young. She then invited Dr. Tapley to offer his comments upon the team test. Dr. Tapley said that he was very glad to be invited once again to judge this competition, for it always gave him great pleasure. The team test was really an easy one, but complicated, and contained two surprises. He reminded the competitors that haemorrhage from a limb always requires elevation, a point which was often overlooked. He was very pleased with the speed with which each team summed up the situation, and he also congratulated them upon their thorough examination of the patient. The standard had been high, and he had thoroughly enjoyed his day there. Dr. Chambers said that it was the first time he had ever judged that competitionand he wondered if he would ever be asked to come again! (laughter). Seriously, however, he had found it a most pleasant duty. He was very pleased with tbe speed with which the tests had been tackled, but there were just a few tiny bits he did not like. They must remember that, because a patient is breathing, all is not necessarily well. They must keep him breathing. No time must be Lost in turning the head to one side, for the tongue can very quickly obstruct the air pa~sages. Moreover, they must get the pallent into the open as quickly as practicable. The test had been set in a tiny space to see how they woulct

FIRST AID & NURSING, MAY/JUNE 1957 react, for he was fully aware of the difficulty of movement in so small a space. For all that, they mLlst take great care that a simple fracture is not converted into a compound one. The part must be handled gently-' as gently as you would handle a piece of Dresden china,' he emphasized. He knew tbat there were tricks in competition, but they must do what they say they are doing. He had been very pleased with the general efficiency. 'Thank you for inviting me,' he concluded. The results, for which all had been waiting, were tben announced: 1. Metropolitan (winning the 'Gracie Lucas' Trophy) 2. B.T.C. 3. City

336~

318 309~

It is noteworthy that less than 30 marks separated the whole of the teams. Mrs. Simpson said tbat she was pleased to see the three forces getting together.

Next year City would be the hosts, and she hoped that tbey would also win the trophy. She felt sure that they would all wish Chief Superintendent Lucas many years of happiness in his retirement. In response to an invitation from the chair, Mrs. Lucas then presented her own trophy to the winning team, after which she and Mrs. Simpson were presented with beautifuL bouquets. Miss Bather thanked Mrs. Lucas for so kindly coming there that day to present the trophy. She also wished to express their very great gratitude to the judges for having judged the tests so impartially. Of the many others she would like to have thanked she could only mention a few-Inspector Williamson for his valuable help, the stewards and patients (if still aLive !), Messrs. Brandon and Morley for the use of the magnificent Section House, and Supt. Miss Yates and her committee. They were all grateful, too, to the ladies who had superintended the tea, to which she then invited her guests.

Sussex S.J.A.B. Finals ONCE again County Secretary C. Simpson and his two Competition Secretaries, W. L. Hancock and D. H. F. Burchall are to be congratulated upon baving carried out successfully the gigantic task of organisil1g both senior and junior first aid and nursing competition finals on the same day, requiring 16 tests to be in progress simultaneously. They were held in the modern Fairlight Schools, Brighton, through the courtesy of the Brighton Education Committee, and attracted a large audience from all parts of the County of Sussex. The tests were of a varied character, presenting many interesting features: THE TESTS

AMBULANCE SECTION Ambulance Team Test, set and judged by Dr. R. Matthews: From their office window the team see a man, lighting a cigarette, fall from the tailboard of a van. The driver goes on, unaware of the mishap. Injuries: Concussion, wounds of left temple and lobe of left ear, compound fracture, left forearm, fracture, left patella. Ambulance Leader's Test, set and judged by Dr. Hughes: He is called to the class-room, where he finds that the teacher has fallen over a chair whilst sharpening a pencil with a penknife. Injuries: Punctured wound (entry and exit) of left hand, simple fractures of 7th and 8th ribs. Ambulance P~ir Nos. 2 and 3 Test, set and judged by Dr. E. M. Newman: They are called to attend a man who has fallen against a desk, sustaining injuries. Injuries: Simple fractures, 7th and 8th ribs., wound in palm of hand, shock. Ambulance No.4 Test-as for Leader.

NURSING SECTION Nursing Team Test, set and judged by Dr. Oyler: The team finds an injured man lying in the road, evidently having been knocked down by a passing car. Injuries: Compound complicated fracture of right leg, fractures of left ribs, shock. Nursing Leader's Test, set and judged by N.O. Miss M. Cutting, S.R.N.: She is required to attend to a patient suffering with an inflamed knee, reapplying KP., and take and chart T.P.R. Nursing Pair Nos. 2 and 3 Test, set and judged by Miss J. Gray, S.R.N.: Required to attend a patient suffering with pneumonia. Re-make bed, changing under-sheet, draw-sheet, and mackintosh, and carry out any other treatment considered necessary. Nursing No.4 Test, set and judged by Div. N.O. Mrs. P. Grainger, S.R.N.: Required to apply liniment and bandage to a painful shoulder. AMBULANCE CADET SECTION Ambulance Cadet Team Test, set and judged by Dr. Thorp: The team is called to attend a man who has fallen from a chair. Injuries: Simple fracture of right forearm, wound of left leg with venous bleeding. Ambulance Cadet Leader's Test, set and judged by N.O. T. Jeffery: Upon entering a shop the competitor hears the sound of breaking glass and discovers that the shopkeeper has met with an accident (exact nature not stated). Injuries: Wound of left palm, with glass embedded, shock. Ambulance Cadet Pair Nos. 2 and 3 Test, set and judged by N.O. J. Hansford: They find another boy who has been injured whilst fighting. Injuries: H aemorrhage from nose, dislocation of left shoulder. Ambulance Cadet No.4 Test-as for Leader.

FIRST AID & NURSING, MAY/JUNE 1957 NURSING CADET SECTION Nursing Cadet Team Test, set and judged by Dr. Gilles Romanes: The team is calJed to render assistance to a girl who has been in contact with a faulty electric apparatus. A second girl meets with an accident after five minutes. Injuries: First patient: Electric burn, right hand. Second patient: Sprained left ankle. Nursing Cadet Leader Test, set and judged by N.O. Mrs. R. Reynolds, S.R.N.: Required to apply K.P. to infected wound on patient's leg. Nursing Cadet Pair Nos. 2 and 3 Test, set and judged by N.O. Mr<;. Tuck, S.R.N.: Required to make bed and change drawsheet for patient suffering from bronchitis. Nursing Cadet No.4 Test, set and judged by N.O. Mrs. B. Rhodes, S.R.N.: Required to apply roller bandage over dressing on left foot. For the presentation of trophies the large hall was packed to capacity, testifying to the popularity of this annual event and the enthusiasm of the members of Sussex. The chair was occupied by the County Commissioner, Lieut.-Col. K. B. Hicks, O.B.E., O.SU., and he was supported by the Mayoress of Brighton, Mrs. Cohen; the Deputy County Commissioner, Maj. P. A. Uniacke; County Superintendent, Mrs. E. M. Courtney; County Surgeon, Dr. H. Rosenberg; County Cadet VicePresident, Mrs. E. M. E. Stewart-Roberts; Area Vice-President for East Sussex, Mrs. W. M. Stuttaford and Vice-President, Nursing Cadets, Miss D. I. Hubbard. In opening the proceedings the chairman thanked the Mayoress for so kindly consenting to present the trophies. He also expressed their gratitude to the judges who had given their time and skill in judging the competitions, as well as to the stewards, time-keepers, 'fakers' and 'patients', and especially to the two competition secretaries, Staff Officers Hancock and Burchall. At this stage the results were announced by Staff Officer Hancock: AMBULANCE SECTION 1. Brighton Police ... 332 (winning the 'Sir William Gentle' Cup) 2. Horsham 321 (winning the' Frederic Cadby' Cup and the' Dorothy Jarvis' Cup) 3. Hastings Police... 314 (winning the' St. John Council' Cup) 4. Hastings (Milton) 302~ 5. Worthing 284k 6. Brighton Ambulance Service 264i NURSING SECTION 1. Hangleton Students (winning the 'Sir William Gentle' Cup, the' Offord' Cup and the' Wyndham' Cup) 2. Brighton... 3. Brighton Students ... ... (winning the' St. .John Council' Cup) 4. Worthing 5. Chichester 6. Crawley ... 7. Renfield ... 8. Worthing Students

289

275 260 248 218

209~

170 167

AMBULANCE CADETS 1. Hangleton ... 273~ (winning the' Hinkley' Cup and the' Trotter' Cup) 2. Lancing and Sompting 264 (winning the' Jarvis' Cup) ... 3. Horsham 253 4. Worthing 243 5. Southwick 232 215i 6. Hastings Town 7. Crawley... 211i NURSING CADETS 1. Chichester .. . 297 ~ (winning the 'Bessborough' Cup) 2. Rye ... ... 289 (winning the' Scott' Cup, the , Bessborough' Cup, the , Sussex' Cup and the' Trott ' Cup) 3. Hangleton 283 & 4. Brighton... 216! 5. Hurstpierpoint ] 97 6. Crawley... 186 163 7. Eastbourne 8. Lancing and Sompting 156 9. Bexhill 145 Judges' comments are always welcomed by both competitors and other members as providing most valuable hints, but as time would not permit of these from all the judges, Drs. Matthews and Oyler and Miss Gray consented to comment on behalf of all the judges. Dr. Matthews laid particular stress upon the necessity of short, clear messages. It would probably have been noticed that in this competition the emphasis had been on fractures, and most of the competitors had done much better than usual in providing the necessary support for these . The provision of a minimum of bandages had been intentional on the part of the judges. He begged them to remember always to bandage the arms to the trunk and the feet together in order to prevent movement. One competitor bad produced a complete first aid outfit from his pocket! Dr. Matthews admitted that, for the moment, this had provided the judge with a problem. Some teams had overlooked the significance of the association

between the vestas found in the patient's pocket and the petrol. The matches had been put there for a reason. Dr. Oyler commenced by saying that honours must certainly go to the students, for there had been a tendency on the part of the older ones to be a little stale. His principal criticism was of the knots, which, in many cases, had shown signs of carelessness. Some had overlooked the oncoming traffic, making no provision for protecting the patient from further possible danger on this account. His concluding shot was' Don't try to palpate a suspected fracture through the clothing.' Miss Gray expressed her complete satisfaction with the standard of work she had judged that day. Most of them knew their text-books well, but they must remember to talk to their patients. 'Put yourself in the place of the patient,' she advised. 'How would you feel if a nurse came in and commenced to carry out treatment without saying a word?' After describing, briefly, the test and drawing attention to tbe principal points in it, she wondered why several of the competitors did not think it necessary to change the under-sheet. A pleasing incident marked the close of the day. Miss Hubbard presented a sealed envelope (although we all knew what it contained!) to Mrs. M. L. Royle, the retiring County Nursing Officer, and expressed the personal affection she had always felt for this splendid officer. Replying, Mrs. Royle tbanked the county for having recognised her services in this way, and said that she was most tOLlched by the kindness she had always received from all. She appealed to them to extend to her successor, Mrs. MacPherson , the same support that they had always given her. FOOTNOTE

We would like to add our personal appreciation of Mrs. Royle to that which was expressed from the platform. We have known Mrs. Royle for many years, and would like to take this opportunity of testifying from our own knowledge to the valuable work which Mrs. Royle has done for the county. She will be greatly missed.

New teaching filmDr. Robert John (Hospital Product Manager of Johnson & Johnson (Gt. Britain) Ltd.), on the right discusses with Major A. C. White Knox, O.B.E., M.e. M.B., Ch.B. (next to him) and Lt.-Col. J. E. F. Gueritz, M.A. (Oxon.) (thjrd from right) and Mr. Craft, Training Officer, the new Camera Talks Unit , First Aid at Home.' The Unit consists of a filmstrip in full colour, wallchart in two colours and .. h I illustrated teaching notes It was presented by Dr. Jolm to the St. John Ambulance ASSOCIation an.d ~s leen pllbli~hed by Camera Talks, 23 Denmark Place, London, W.C.2, who are also the dlstnbutors.

FI R ST A ID & NUR SING, MAY JU E 1957

East Sussex Constabulary First Aid Competition , Francis Taylor' Shield IT is not to be assumed that, because we are usually afforded greater facilities for reporting London Police Competitions, first aid activities amongst the police of the provinces are any less? an~ if evide~ce is required to support thIS claIm, then It was certainJy provided by the East Sussex Constabulary F.A. competitions held at the Have Town Ha[l, through the courtesy of the Mayor and Corporation. Six teams from all parts of the area competed for the . Francis Taylor' Shield. Like most major competitions, each team had to submit to a team test and individual practical tests, and each test provided many points of interest. Team Test, set and judged by Dr. F. M. Stuttaford, O.St.J., M.R.e.S., L.R.e.P.: Returning from a competition in a strange to\\-11 in a station brake, the team find a man who has fallen from a window amongst broken glass. By a coincidence the engine of the brake stalls, but the brother of the fallen man happens to be a

motor mechanic who can repajr the damage, when the car can be used to take the injured patient to hospital. A unique turn is given to the test by making the mechanic brother dumb. Tnjuries: (main patient): Fractured base, compression later (swa[lows blood), fractured ankles, contusion, right forearm, with mixed bleeding. (D umb brother): Bruised muscle, left forearm. Indi vidua l T est for each member. set and judged by Capt. J. M. Buckley, S.B. St. J.: Competitor is called to a house, where he finds a man lying on the floor, having fallen from a chair. Injuries: Simple fracture, 7th and 8th ribs, right side, wound in palm of hand (table fork), shock. Occupying the platform at the presentation ceremony were Aldennan and Mrs. e. A. Clarke (Mayor and Mayoress of Have), Mr. R . Breffitt (Cruef Constable of

East Sussex), Mr. S. Leader (Assi tant Chief C onstable of East Sussex), Mrs. Stuttaford and the judges. Following the judges comments, in which the teams were congratulated upon their high standard, the results \-\"ere announced: 1. Have 398;t (winning the' Francis Taylor' Shield) 2. R ye 379~ 3. Lewes 374i 4. East Grinstead 334 5. Battle 326 6. Hailsham 30S} Best individual: P.e. Tomlin, of Lewes 76 74 R unner-up : P .e. Brooker, of Rye

In response to an invitation from the chair, the Mayoress, Mrs. Clarke presented the trophy to the ~ inning team. A vote of thanks to the stewards, patients, and especialJy to the juctges, brought to a close a most enjoyable event, the arrangements for which had .been in the capable hands of Sergt. A. E. Burstow, the Competition Secretary.

• From a seat m the audience Some Random (and Provocative) Comments on the Competitions Sussex S.J.A.B. It was not difficult to distinguish those nurses who had had hospital experience from those who had not. Don't forget to ' loosen' the bedclothes before commencing. More than one patient was unnecessarily exposed in bedmaking. Some were very clumsy in rolling the sheet. This requires practice. How many more times? Palms DOWN in tucking-in. 'Is the stretcher ready?' Where are your eyes? , Lift!' They' d already lifted! , We're going to clear up after us '-but tbey didn·t. Weren't the ladies capable of blanketing the stretcher for themselves? Should you have a couple of minutes to spare before 'Time' don't spend them 'fiddling about.' , Patients' should be awkward rather than helpful. Don't improvise \",hen F.A. material has been specially provided. He carried a . kettle of boiling water' by the spout. How this emphasised our frequent criticisms of' gestures.' Don't ring' Hospital,' , Doctor,' 'P o lice' etc. R ing 999. Who mixed up the trophies? Lady Abbiss One ratient was rather too ready to furnish information unasked. Some overlooked the new teachingsemi-prone position. . I should not have applied smelling

salts.' Too late. The damage was done. 'It's a good job you don't smoke. I haven't got any fags.' Was it necessary to re-dress the wound? Tea, hot water bottles, blankets, etc., 5hould nor be produced in obviously impossible circumstances. This is becoming a fetish. Judge should not have asked . How ster.ilise?' He should have allowed her to carryon, pointing out the absurdity afterwards. Tripping over those steps, she nearly became a casualty herself. Most of the leaders knew their text-book thoroughly but their work was too mechanical. The human touch (' bedside manner .) was absent. D on't commence to un pack kit u ntil you know what materials will be required-if any. How those ladies could talk! Was that handkerchief as clean as it was claimed to be? [t is not necessary to raise one end of the stretcher in testing. We have often wondered how this habit developed. All those details were u nnecessarv in message to hospita l. What became of the bee? Frantic efforts to fi nd it. It is not often we see ladies use th e' fore and -aft' method. We were informed by the judge that only two e levated the arm . Gracie L ucas What is the use of tea to an unconscious patient?

'What's happened?' Surely it was obvious. Patients MUST resist the temptation to help. Judging by the angle at which it was held there couldn't have been any water left in it. P atting the limb is not 'promoting

circulation.' D on't say' tactful message.' Repeat the wording of the message and leave the judge to decide whether or not it is 'tactful.' In any case it should be W R lTTE . We have never before seen the judge provided with a special table. It was a wonderful picture-it was smashed three times! 'Where's your mother, out at ""ark?' This seems to be taken for granted these days. She worked hard at . promoting circulatio n '-all on on e arm. We would advise the removal of the stopper before applying smelling salts! More gestures. Was it necessary to make uch an exhibition of' removing cause'? Why use your tunics ~ hen rlenty of blankets had been provided? \Vas it to show off those pretty blue shirts? L ondon T ransport O f the five joint stock banks, why was the Mid land selected as a backcloth? We could see no reason for removing the patient from the p:lVem~nt into the road. How unconcerned the sawyer appeared to be, despite the calamity. Haemor rhage from the bitten tongue perplexed some.

FIR ST AID &

URSI G, MAY JU lE 19S7

' at all thought of the broken glass above. Query: Should the stretcher be brought by the competitors or by the ambulance attendant? Why not a ruling on this? We would like to see stretcher loaded into upper berth sometimes. Is the use of roller bandage first aid? Some competitors were obviollsly inexperienced. We do like to see the judge examine the bandaging aften\ ards. Lim b should be ele\'ated IMMEDIATELY, and supported in that position. In actual cases many simple fractures would be converted into compound. This should be assumed by the judge and marks debited accordingly. Judges are too lenient. If competitors would bear constantly in mind those three giants, Haemorrhage, Asphyxia and Shock (H.A.S.) there would be far less blunders with consequent los of marks. Some teams did not appear to appreciate fully the urgency. Why all those preliminaries before attending to the patient? The patient was bent like a bow. If his spine had been fractured . . . She tested stretcher by crawling slo\\ ly along it. Judge: 'Are you asking me or telling me? ' 'Did I take his name?' Can't you remember? Security measures were not as strict as they might have been. We saw more than one contact between competitors and spectators. Judges could discourage unnecessary que lions by ignoring them. · l'm taking his pulse.' Doubtless the judge was grateful for the information, othen>,ise he might have thought she was polishing his shoes. There were four on one side and one on the other (blanket lift). Should the ambulance attendant be regarded as a trained man or not? • Will you 'phone for ambulance.' 'J\'e already done so.' She had noL ho\\~\"er, received instructions from the competitors to do so. , Ha\e you got another blanket, lady?' There were t\\ a right under his nose. Judge: ' Look at the patient, not at me: 'Have you a nice warm fu'e in your room?' We'\'e never yet seen a cold one. We do like to see the judge make himself comfortable. We saw three competitors attending to a simple faint, leaving rhe remaining member to deal with the main casualty. Was it necessary to send a simple faint to hospital? We ~ould like to have had a record of the comments of the CO. or the sister. · I would elevate the foot of the stretcher.' Well, do it, then. Only one team thought to remove couch from wall, thus enabling attendants to \\ ark: from both sides. . The number of signals from tImekeepers'table could easily be reduced, and even then they should be silent one . H is ah\ays interesting to speculate as to ~ here stretcher wi[[ be placed.

* First-Aide~s Crossword No. 28 Compiled by W. A. Potter

ACROSS ( 10) Fracture of a sicker gent (4) River of Wales and Scotland May produce a rainbmy from (5) white light ... ... . .. 11. Sometimes fractured in ' sprain' (9) of ankle 12. Was at sea with the butcher ( ) and baker 13. Speech from person with (S) coryza (6) IS. Hastier at breakfast? 16. Deteriorating, yet decent about (8) our time ... 19. The patella or pisiform for (8) example (2,4) 21. Entirely Roman 24. Duodenal, rodent, or \"aricose (S) may be met (8) 26. Rest for the heart 28. First and second of wound (9) healing ... ... . .. (S) 29. Staggers, but dances in Scotland (4) ]0. To which 13 refers 31. Spreading ubcutaneous infec(10) tion 1. 6. 10.

S OLUTIO ~ TO

ACROSS Antibodies: 6, Long: 9, Llama; 10, 'Operation; 12, Asthenia: 14, A tear; 16, Toodle; 18, Despatch: 21, Ect.ozoon; 22, Red eye; 24, Train; 26. ParasIte: 29, Implement; 31, Obese; 32, Open; 33. Manchester. 1

1. 2. 3. 4.

7. 8.

9. 14. 17. J8.

20. 22. 23. 2S. 27.

DOW:\, (4) Stare at open wound Injury may interfere with growth (9) of bone (7) One mine, perhaps is named .. Anatomical region for barrister (6) or priest Oil scare in all food in some (8) degree (5) Food ready for s\\'a1l0\\ ing Clearing up of inflammation (10) \\ithout pus formation (6) Rupture an heir Fracture complication. Sounds as though there may be a (5,5) strike ... (9) Lemon tile" ill soothe the skin Airwav must be used in all (8) weather (6) R emain for a change b) the sea (7) Hi tory of life (6) Anima[ (S) Quotes .. , (4) E'Cist 1\\ icc at O:--.ford

CROSSWORD No . 27 DOW;\, Ails: 2, Transport: 3, Brash: 4. Dro\\ns; 5, Ewe; 7, Olive: 8, Gonorrhoea; 11, An apple: 13. Ages: 15, Intertflgo: 17, L?~enge: 19, Trea!ment: ~~, ~up: 23, Cntlc; 2S. Amp[e; 2 /, Stone. _3. J. ear, 30, Eva . 1,

FIRST AID & NURSING, MAY/JUNE 1957

First Aid Saves Lives in the African Bush Well-organised first aid training in South Mrican gold mines and collieries has brought inestimable benefits to tribal communities in outlying kraals and villages. trained in first aid on N ATIVES, the gold mines and collieries of South Africa, have frequently performed outstanding acts in saving life and limb not only in the mines but also on return to their home villages-often far from the nearest doctor or hospi,taI. Floating in shallow water ... Many cases have been recorded of natives acting promptly and skilfully in applying their first aid knowledge. One African turned his training to good account by saving the life of a man whom he found lying unconscious on a lonely stretch of beach. A European fisherman had seen the man floating in shallow water. He waded in and pulled the body out but then-not knowing first aid-he hurried for help to the nearest police station two miles away. When he returned he was surprised to find the 'drowned' man sitting up talking to a native who, on seeing the body, had immediately diagnosed the trouble and quickly and successfully applied artificial respiration. Each year more than 40,000 South African mineworkers qualify in first aid. Such training began in 1922 under the direction of the Prevention of Accidents Committee of the Chamber of Mines with the approval and co-operation of the South African Red Cross Society. Since then nearly three-quarters of a mjUion native mineworkers have qualified. In availing themselves of this training, which is voluntary, they have shown remarkable keenness and zeal. Experience has shown that natives who offer themselves for training generally assimilate rapidly and thoroughly aU the lessons. Instruction follows a manual, and lessons are given mainly by practical demonstrations with the students themselves acting as 'patients' or , victims '.

Competition cash prizes! Each year ambulance competitions are arranged in which native teams take part. A t these compeb tions cash prizes are given by the mining authorities, while medals and badges are awarded by the Prevention of Accidents Committee. Last year more than 15,000 natives entered. In a recent survey to assess the benefit of this training amongst mineworkers who had returned to their homes and villages no fewer than 360 incidents were reported. These showed that African firstaiders were able to alleviate suffering in a wide variety of cases. Stabbing wounds have been treated successfully; broken limbs have been splinted and, in a few cases, the fractures mended without being seen by a doctor; tribesmen and children have been revived after being rescued from rivers, lakes and dams. First aid for a chicken's leg First aid has been given after tree-felling accidents; from bites and mauling by wild animals like crocodiles, leopards, hyenas and lions; for injuries caused by horses, donkeys and cows, and from goring by bulls. Prompt treatment has been rendered in car, bicycle and rail accidents; for burns; for sporting inj uries and hunting wounds. Asphyxiation by smoke and fumes, and a number of cases of attempted suicide have also been successfully treated. Even the livestock has cause to be thankful, for first aid treatment has often been extended to oxen , goats, sheep and dogs. Also recorded is a successfully mended fracture of a chicken's leg! Here are two stories which illustrate the high dGgree of skill achieved: Some natives were out hunting when one, who carried a shot-gun, saw a movement in the tall grass and fired. To his horror he discovered

he had killed another native whereupon he immediately drew his hunting knife and cut his own throat. In the party was a trained first-aider who, on recounting the story later said: 'I immediately took off a triangular scarf and lightly bandaged round the collapsed man's throat. I then brought his head forward in order to close the wound as much as possible. Assisted by others, and keeping his head well forward, I had him carried to his hut. There I bandaged him again, usi ng clean sheets. I also strapped his head well forward so that nothing could move, and covered him with blankets.' Carried for two days The stricken native was then loaded on a primitive ox-cart and carried over rough tracks for two days to the nearest white doctor. During this time he was constantly attended by the native trained in first aid and eventually gained consciousness. On arrival at the doctor's the neck was stitched and the man eventually completely recovered. Attacked by a crocodile An equally serious incident was or a man attacked by a crocodile. He was pulled under water by the thigh and only released when his comrades beat the crocodile with sticks. With a severely bleeding wound and well nigh dead from drowning, the unfortunate victim was restored by a quickly applied tourniquet followed by artificial respiration. Expert treatment in hospital ensured a full recovery. Small wonder that nati ves versed in the art of first aid are greatly esteemed by their fellow tribesmen. So much so that in some communities they are given land and livestock as an encouragement to settle and practice their life-saving skills.

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queries Answered by Dr. A. D. Belilios W. C. (Lanes.) writes :A patient is brought in unconscious on a stretcher and may be breathing, but hall' do the Casualties Union simulate' breathing stopped.' Sometimes N.P. (no pulse) is marked on the wrist. Does this indicate the patient to be dead or does it mean that artifidal respiration should be commenced pending the M.O.'s examination , and lVould I be in order to take him off the stretcher at once to do so. It sounds involved, I agree, and in real life I should imagine a person 1'1'0uld be dead, but for the pUlposes of a competition, of course, things are sometimes altered to study the first aider's ability. I have tried to get this problem straightened out so that we know the basic way to proceed, but no one seems to be certain of the solution. I would like to knolV then how 'breathing ceased' is faked. Does N.P. on the wrist mean the patient to be dead or does it indicate A.R. Would [be correct to get my patient on to the floor at once till he revives, or I am told he is dead by the judges or my team M.O.

Answer , No pulse' does not mean that a patient is dead; in some illnesses, shock, etc., the pulse is so weak that it cannot be felt. A doctor may sometimes even find it difficult to

hear the beat of the heart in these cases. 'No pulse' is not necessarily an. indication for artificial respiration; the breathing must of course be most carefully watched and the first aider be prepared to give artificial respiration immediately should it show signs of failure. Indication that breathing has stopped depends on the judges. A card can be used or the patient coached to breathe very shallowly or even stop temporarily when the first aider is obviously examining the respiration.

c. c. P. (Ilford) writes:With reference to the report on St, John Regional Officers' Course in current issue of First Aid & Nursing. One paragraph referred to burns of the face. Mr. Beare said that nothing should be put on the injuries at all, but suggests that soda-bicarb. , although not doing any harm IjJould do no good. May I infer from these remarks that the surgeon's job is made more difficult by the first aid treatment recommended in St. John F.A. Manual, at the same time perhaps depriving the patient of a little comfort and ease from his painful injuries, plus the possibility of further infection? As a keen S.J.A .B. member and not quite clear in my own mind as to the precise meaning of these remarks, I would be grateful if Dr. A. D. Belilios lVould comment on this one paragraph. May I say that I have the highest regard for the plastic unit and the good H'ork they have and are still doing for the cause of humanity.

Answer

There are often different schools of thought in medical work but they

obtain equally good results. Personally I believe in the standard first aid methods but do not think your inference is correct. You must of course, use your discretion. Obviously if hospital services are readily available (e.g. 999 calls) there is very little object in applying a dressing. R. F. F. (Epping) writes:A friend of mine is suffering from a diaphragmatic rupture or hemia. I cannot find any reference to this in first aid books and should be grateful for some information.

Answer

This is an internal condition in which some of the contents of the abdomen, e.g. part of the stomach bulge or protrude through the diaphragm into the chest. It often dates from birth and may cause no symptoms; on the other hand the patient may develop persistent dyspepsia resembling that of a gastric or duodenal ulcer. Complications such as haemorrhage or strangulation may occur. G. M. (Edwardsville) writes :At one of our Divisional practices after a lengthy discussion, we concluded with a difference of opinion on the method of turning a patient, It'h ell ly ing on his back, to the prone position, to commence HolgerNielson method of artificial respiration. Supplement to the 40th edition of First Aid to the Injured, states : Go down on the right knee, opposite the patient's head, place the left foot 017 the ground out to the side. Now the controversy is: some of OUI' members kneel on the right knee at

FIRST AID & NURSING, MAY/JUNE 1957

his head, in line fa cing the patient's feet, left foot out to the side. Other members kneel on their right knee, opposite the patient's head, on the side of the patient, left foot out to the left. We could not agree which is the correct position of the operator. Answer

In my view, the best method is to kneel on the right knee, at his head in line facing the patient's feet, left foot out to the side ; arrange the centre of the body slightly to the right of that of the patient. S. H. (Wakefield) writes:As a k een and active first aider, I regular(l' read y ouI' ans wers to readers queries. Would ),OU be so kind as to give me some information on the changing of operators during the application of ' Holger-Nielson Artificial Respiration.' Answer

I would suggest changing at the end of a completed cycle, the relief first aider arranging himself on the right of the operator so that he can quickly slide himself into position as his colleague moves out to the left, the relief should then begin by producing expiration. -

Book Review , Sports Injuries-their prevention and treatment,' by Donald F. Featherstone, Published by John Wright & Sons Ltd.) The Stonebridge Press, Bath Road, Bristol 4. Price 35/-. 200 well illustrated pages. Injury is the occupational hazard of sport, but the treatment of these injuries does not receive a commensurable degree of attention or foresight by those doctors and physiotherapists responsible for treating the athlete. As a result of his experiences with athletes (both amateur and professional) of many sports, the author is convinced that a different approach and a greater sense of urgency are required adequately to cope with the recent injuries of everyday life. To cater for this need the author ad.vocates the high pressure systems of treatment used very successfully during a number of years with professional football and cricket clubs and outlined in this volume.

Dr. D. Towle It is with deep regret that we learn of the temporary partial retirement from the competition field of Dr. D. Towle, for reasons of health. Dr. Towle is a young and enthusiastic competition judge with progressive ideas, and his loss to this depart ment of ambulance and nursing work will be keenly felt. We sincerely trust that after the twelve months rest which has been suggested Dr. Towle will be able to return to this work which we know he loves. First Aid and :f.'lIrsing wishes Dr. Towle a speedy and complete recovery. Dr. Towle judged the London Transport Finals reported in this issue_

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314 Kingston Road, Wimbledon, S. W.20 Telephone: UBerty 2350 & 7058

47 High Path, London, S. W .19 Telephone: LIBerty 3507

Printed by HOWARD, JON E S, ROB E RTS & LEETE , Ltd 26-28 B r str . the Proprietors , DALE REYNOLDS & Co Ltd t 32 'p' b Us y eet, St. Mary Axe, London, E.C.3, and publIShed by , -, ., a InS ury quare, London, E .C.2, to whom all communications should be addressed.

UNqUESTIONABLY THE REMEDY SKIN INFECTIONS are primarily caused by Staphylococci, Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms. ANTIPEOL CUTANEOUS OINTMENT incorporates the sterile broth filtrates of the three infective microbes in an ointment base of proved efficiency. AS A TREA T MENT for burns and scalds, ANTIPEOL OINTMENT is both non-adhesive and bactericidal, thus obviating the need, when not convenient, of changing the dressings every day. FOR CUTS, ABRASIONS, BOILS and numerous skin infections, ANTIPEOL is unquestionably the

remedy. It is already in widespread use by the medical and nursing professions in many parts of the world. TO PUT ANTIPEOL TO THE TEST, send for your Tree clinical sample,

ANTIPEOL is an essential component of every First Aid and -Nursing Kit.

anti .e I cutaneous ozntment

Produced by the makers of: ENTEROFAGOS for intestinal complaints. RHINO-ANTIPEOL for naso-pharynx infections. OPHTHALMO-ANTIPEOL for ocular infections. DETENSYL for reducing arterial tension.

MEDICO. BIOLOGICAL LABORATORIES LTD., CARGREEN ROAD, SOUTH NORWOOD, S.E.25 6

FIRST AID & NURSING, JULY/AUGU ST 1957

UNIFORMS and LADIES~ GREAT COATS & COSTUMES MEN~S

for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

First Aid &

Nursi••g Editor: P eter I. Craddock T his journal is published on the 20th of Febr uary, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.C.2, for the purpose of providing an informative technical ser vice on first aid a nd nursing. We welcome contributions.

JulyIAug. 1957

DOBSON & SONS (London)

UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS 154 - 164 TOOLEY STREET LONDON BRIDGE S.E.1

Diseases of the Blood ...

' Phone:

Casualties Union News

Competitions ...

What Do You Know?- No . 1.

Hop 2476 (4 lines)

'Grams:

"Hobson, Sedist, London"

D!!D!!'-----...

t -._

PATENT

"lJ

"PORTLAND" AMBULANCE GEAR

Correspondence

Book Review ...

First-Aider's Crossword No. 29 12 How Old is First Aid?

Readers' Queries

no you know that • ••

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

Roath Lake, Ca rdiff. is the only place in Great Britain in which bather 's itch (Schistosome dermatitis) is known to occur? T rephining is said to have been practised by Neolithic man? O f the total oxygen breathed in during 24 hours, 67 % is taken in between 6 a.m. and 6 p .m., a nd the rema ining 33 o~ between 6 p.m. and 6 a .m. ? Tr ypanosomes, the m inute parasites which cause sleeping sickness, were first discovered and described by Castellani in 1902? The heaviest man ever k nown was Daniel Lambert, a native of Leicester, who, when he died at the age of 40, weighed 52 stone 11 lbs. ? T he peculia r form of insanity, in which the patient, often a n otherwise respectable citizen, uses filth y a nd obscene language, is called coprolalia?

B. Shows the top stretcher lowered read y for load ing. C. Ill ustrat es the sa me Gear WI t h the top stretcher fra me hin ged down for use when only one stretcher case is carried. O. Shows t he same posit ion as in .. C " only with cushions and b ac k rest fi tted for con valescen t cases.

Where Ambulances are required to carry four beds two Gears are fitted . one on EITHER SIDE. and the s·a me advantages apply as described above . Fu l l ccnologue of Ambu lance Equ ipment N~ . 7A will be Sen! on requ~t .

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

From a Seat in the Audience 11

The Gear iIIustrated(A.B.C.D.) carries two stretchers on one side of Ambulance. leaving other side clear for Sitting patients.

A. Shows the t wo stretchers in position.

In this Issue

65, WIGMORE STREET, LONDON, W.I 'Phone: WELbeck 0071

Retirement of General Hawes M AJOR-GENERAL L. A. Hawes, who was the Controller of the British Red Cross Society's Home Department has .. recently resigned from his position. General Hawes is the efficient public servant who evolved the emergency scheme on Army lines for handling peace time disasters and for training personnel for such relief work on a visual basis. This method was described in an article in the September/October 1955 issue of this journal. General Hawes had a distingurshed Army career. In the 1914-18 war he received the M.C., D.S.O. and was mentioned in Despatches four times . A highlight of his service between the wars was during the period 1934- t937 when he was serving as instructor at the Staff College, Quetta. He was in the Quetta earthquake and for a month was responsible for all the relief work. This experience stood him in good stead when he helped to organise British Red Cross Society relief measures for the floods in 1947 and later. In 1938-1939 served on General Staff, War Office as G.S.O.l. (Plans), a new appointment. He was responsible for all moves of troops and stores to all theatres of war which took place in September 1939. From 1939-1940 he served as Brigadier General Staff H.Q. Eastern Command. Was awarded C.B.E. in 1940. 1941-1942-M.G.A. A.A. Command. 1942-1945 was Commander South Midland District- comprising all troops and installations in Oxfordshire, Berkshire and Gloucestershire.

The Princess Royal presenting General Hawes with a radio set and cheque subscribed to by Red Cross members throughout (the country.

As B.O.S. Eastern Command he helped to initiate Civil Defence plans and measures to meet invasion. When commanding S.M. District he was closely concerned with civil administration in all its aspects and acq uired a knowledge of Local Government and Civil Defence, which was of the greatest value to the Society and his work with it. General Hawes joined the Society in September 1945, and as a result of his Army experience introduced modern visual methods of training, as mentioned above, in connection with the Society's disaster relief work. He is a qualified first aider and has undertaken routine first aid duties.

Hospital Equipment and Medical Services Exhibition FOR the first time suppliers and manufactw'ers of hospital equipment have an opportunity of exhibiting under one roof. The 1st International Hospital Equipment and Medical Services Exhibition is to be held from May 5th to 10th, 1958, in the Empire Hall, Olympia.

The exhibition will cover approximately 50,000 sq. ft. and the cost of space is to be 19s. 6d. per sq. ft., including shell sc~eme. A limited area on the ground floor WIll be available without shell scheme at 16 . per sq. ft. . .. . Details of the exhlbltlOl1 are avaiJable from Contemporary Exhibitions Ltd., of 40 Gerrard Street, London, W.l.

Forthcoming Events September 13th October 6th October 11 th October 23rd November 6th November 14th

National Fire Brigades Finals, Southport, 2 p.m. Cas ualties Union D ay, London University Sports Ground, MotspUJ Park. Gas rndustry Finals, Friends' House, Euston Road, 9.30 a.m. G.P.O . Finals, Porchester Halls, Bayswater, 9.15 a.m. Dock and Harbour Authorities Finals, WestOll-super-Mare. Grand Prior's Troph ies Competitions, Porchester Halls, Bayswater. 9.30 a.m.

FIRST AID & NURSING, JULY/AUGUST 1957

A Course in Elementary 1t1edicine

THE blood is liable to many diseases, some of which are common in everyday life and of great importance. It is proposed to discuss some of the more prevalent of these ailments in this article but before this description it is desirable to revise our knowledge of blood. Blood is a thick red fluid and there are approximately ten pints in the human body. It is made up of two parts, a liquid portion called the plasma and a solid portion which includes the corpuscles. The plasma is astra w coloured fluid such as is found beneath a blister. It contains water, salts and food products which have been digested and are being carried tv the tissues of the body and also waste matters which are being removed from the tissues. The corpuscles are very minute cells and are divided into two main groups, the red and white corpuscles respectively. There are also the blood platelets. The red corpuscles are very numerous-no less than 5,000,000 in each drop of blood which is calculated to be a cubic millimetre. They contain a coloured pigment called haemoglobin; this possesses the power of combining with oxygen while the blood is circulating through the lungs. Hence the red corpuscles carry the oxygen round the body to the tissues. The white blood corpuscles are larger than the red but less numerous -only 6,OCO in each drop of blood. They are, however, of various differe.nt types which can easily be distmgUlshed under the microscope. They are often called the' defenders of the body' because their chief function is to devour germs which have entered the body. During this process, white blood corpuscles may be destroyed and their dead bodies together with Iiquified dead tissue form the pus or matter which is found in a boil or abscess.

Diseases of the Blood By A. David Belilios M.B., B.S. (Land.), D.P.H. (Eng.) The third set of cells are called the platelets. There are abollt 250000 in each cub.ic nullimetre and they are concerned m the process of clotting. Anaemia . Th,is. is the term applied to a COndJtlOn of the blood when there is a deficiency in the number or quality of the red blood corpuscles. There are many different kinds. A naemia may result from loss of blood through wounds or disease. This loss may be acute or chrOluc. An acute loss results from severe and sudden bleeding from any part of the body,. e.g. the stomach, lungs, etc. Chrome loss may be due to repeated and continuous slight haemorrhages, thus patients suffering from a duodenal ulcer may lose a small quantity of blood which may not be recognised over a prolonged period of time. Deficiency anaemias are caused by a defective supply of the materials necessary to make blood. Of these the two most important are iron and a sub~tance called the pernicious anaeITlla factor. Defective supply of the former causes what is often called an iron deficiency anaemia' of the latter a disease is known a~ pernicious anaemia. Some kinds of anaemia are due to excessive destruction of blood within th~ body. For example, certain P01S0l1S such as lead and benzene are responsible for chronic anaemia in a patient frequently in contact with thes~ substances. The poisons (toxms) may also be derived from the germs of diseases. Hence those who have suffered from scarlet fever rheumatic fever and septicaemi~ amongst other complaints are liable to become anaemic. Symptoms These natural~y vary with the type, cause ~nd seventy of the complaint. There IS usually a feeling of ill health,

l?ss of appetite, palpitations and a !tttle shortness of breath; in the more severe cases, giddiness, headaches and indigestion may occur. ~ characteristic feature is pallor ~hlch affects the lips, cheeks and the ll:ner surfaces of the eyelids. This sign however, may be deceptive sin~e the colour of normal people vanes so .enormously. A nicely br<;)llzed skll1, for example, can hide qUlte a marked amount of anaemia whil~ a pale-faced individual may not, Jll fact, be anaemic. There is only one certain method of proving the presence of anaemia and that is by having a blood test perfor~ed. A small drop of blood IS obtallled by pricking the finger or the ea~. This measured drop of blood IS then examined under a microscope and the precise number of red blood corpuscles in each cubic millimeter can be easily determined together with an accurate estimat~ of the. amount of haemoglobin present 1Il each corpuscle. A blood count of this kind, which also includes the white corpuscles and plat~lets, is often most important in medIcal work particularly in the iron d~fi cjency anaemias. Many a patient wIth a pale face has dosed himself quite unnecessarily with iron for a p~olong~d perio.d of time causing hImself mconvemences to say nothing of expense. The characteristics of sudden and severe loss of blood should be known to every first aider. I n the first pla~e th~re is shock, the patient feel mg. giddy, faint and possibly swoonmg; the pulse becomes quick and feeble, the temperature of the body subnormal and the skin cold clammy and covered with sweat: ?allor is of course present and there ]S lo~ s of the normal pink colour of the lLps, cheeks and finger nails. . Thirst is a common symptom and IS due t~ loss of fluid from the body. Tl~e patJel~t may continually ask for dnnk whlch, however, should be

FIRST AlD & NURSING, JULY /AUGUST 1957

withheld until the haemorrhage is under control when it should be given little and often. Breathing is difficult-quick and shallow and gasping. There may be the feature of air-hunger such as clutching at the throat, attempting to undo his own tie, etc. Restlessness is an important characteristic. If in bed, the patient wHl move about from side to side, sit up and then lie down again no matter how much he is advised to be still or even restrained. ]f the bleeding remains uncontrolled, singing in the ears and mistiness of vision precedes the ~radual sinking into a state of coma in which the patient dies. Pernicious anaemia This is another example of the deficiency group of anaemias. The bone marrow fails to manufacture an adequate number of red blood corpuscles which are therefore markedly reduced numerically in the blood although their haemoglobin content remains relatively high. The typical symptoms and signs of a chronic deficiency anaemia are present. In addition the patient often develops a yellow tint to his skin. Soreness of the mouth and severe attacks of indigestion are other characteristics while a form of partial paralysis called subacute combilled degeneration of the spinal cord may be an added complication. In this complication, numbness and tingling in the legs is followed by difficulty in walking. Until about 30 years ago, pernicious anaenua was a fatal disease and commonly but incorrectly called 'cancer of the blood.' Then came the discovery of the value of liver as a method of treatment and nowadays patients can live comfortable and satisfactory lives provided they keep to regular injections of this gland. In addition various alternative remedies have been introduced. Leukaemia Just as there are a number of ailments affecting the red cells so also are there complaints which affect the white blood corpuscles. Of these leukaemia is not Ullcommon. It is a disease of the tissues in the body which make the white cells and

is characterised by a considerable increase in the number of white corpuscles in the blood. This increase may be up to 100,000 or more per cubic mil1imetre and may give the blood a milky appearance, hence the name of the disease. There are two main vanetleschro~uc myeloid and chronic lymphatlc leukaemia respectively. OccaslOnally an acute form occurs which will be referred to later. Symptoms and signs of the chronic varieties develop gradually. There is progressive weakness, fatigue and breathlessness. In the myeloid type, the spleen becomes enormously enlarged and may cause increased size of the abdomen. In the lymphatic variety the spleen is only moderately enlarged and the characteristic feature is an increase in size of the lymph glands in various parts of the body-e.g. the neck groins and armpits. Bleeding from the nose, mouth or gums may occur. Chronic leukaemia is a progressive disease although modern treatments may result in the patient living for many years. H aemophilia This is a well known but fortunately comparatively rare disease in which there is a tendency to uncontrollable haemorrhage. It is due to a deficiency in the clotting powers of the blood probably caused by an abnormality of the blood platelets. It is an in..herited condition which runs in families ; it is usually handed down by females to their male offspring. Prolonged bleeding may result from minor wounds, the socket of an extracted tooth, tile nose, etc., and the patient's condition may become grave. Those susceptible to haemophilia must avoid all types of injuries and shollid inform doctors and dentists of their affliction should at any time the question of an operation or dental extraction occur. If bleeding occurs, direct digital or pad pressure must be applied and a doctor obtained or the patient taken to hospital as soon as possible. Medical methods of stopping the bleeding include the use of snake venom; thus a bleeding socket may be packed with cotton wool soaked in this substance. Blood transfusions may have to be undertaken.

Casualties Union

News BUXTON TROPHY THE regional eliminating rounds for the Buxton Trophy were held in July throughout the country. The competition this year has attracted even more teams with. a .total entry of 168. The lucky finalIsts III each round, now compete in the finals, to be held at Motspu r Park, London, on October 6th, 1957. Do deal with the substantial increase in the number of teams competing, additional regions were formed, and many more spectators were able to be present to witness the competitions. RECENT DEVELOPMENTS The better casualty simulation becomes the better the scope is offered to it, Recently members were asked to provide patients for the examination of nurses for State Registration. They have also served on several occasions for the Royal College of Nursing in their annual competition for the Marion Agnes GuLlen Trophy, and this year provided casualties for the Agnes Elizabeth Pavey Shield Competition. All this shows that trained casualties must aim continually at the highest possible standard-the faithful portrayal of a sick or injured patient. This sets a standard for us all. NEW PUBLICATIONS Part one of the new publication of CasuaLties Union, 'The Atlas of Injury' made its appearance recently. It is intended to publish three more parts in the not too distant future. The first part contains full and illustrated information of 13 difTerent injuries and diseases. With its diagrams and illustrations it will be a valuable text book for first aiders as well as for every group of trained casualties. Copies can be ordered through Headquarters at 2/- each. Confessions of a Competition Casualty HolV pain/tti it is to hGl'e one's long hair caught lip in the blanket and then IIsed as an additional lifting del'ice. How sick one feels when carried any distance on a bouncing stretcher. HolV terribly pain/trl it is to be laid across a wheelbarrow, witholl! any padding underneath, How lVarm and comforting a first aider's coat can be, to a casualt), lying in the rain.

Camera Talks Filmstrip: 'First Aid at Home.' We have been asked to state that it was omitted to mention in our last issue that the filmstrip: 'First Aid at Home,' Wallchart and Illustrated Notes, were produced in co-operation with and under supervision of the St. John Ambulance Association. A picture taken on the occasion of the presentation on publication day was published in our last issue.

FlRST AJD & 1'-.TURSING, JULY/ UGU T 1957

Competitions The 'Dewar and Perrott' Finals of The St. John Ambulance Brigade

A OTHER 'Dewar and Perrott' has

come and gone, and the excitement \\hich has permeated the Brigade for many weeks past is now subsiding. The teams are studying their marking sheets, correcting their errors and preparing to do better next year. The great annual competitions were held in the Central Hall , Westminster, and attracted a large and enthusiastic gathering of supporters and spectators, for the teams represented Divisions from all parts of the United Kingdom. In truth, it was a triple event, combining the finaJs of the men, the nurses and the cadets, but, despite the m~gnitude of his task, Mr. Quilter, the Bngade Secretary, is to be congratulated upon having engineered it without a hitch. 46 teams took part, and at times during the day 16 competitions were in progress at the same time. The various tests are well worth studying: Ambulance Team Test, judged by Area Surgeon W. Duncan (Duke of Lancaster's District): The scene is a racecourse. A jockey has been thrown and brought to the first aid hut. InJu!ies: Dislocated knee,. chest injuries, complIcated fractures of nbs, laceration and bruising of chest, haemorrhagic shock. Nurs~g.Team Test, judged by Area Com-

rrussIOner Dr. G. M. Shaw Smith (London District): A lady. preparing afternoon tea, trips and fall.s with a trayful of crockery. InJunes: Wound on head with sligh t h~emorrhage, severe cut on right forearm WIth tendons severed, dislocation of left s~oulder, simple fractures of ribs on left SIde. Ambul~n~e

Cadet Team Test, judged by ComrrussIOner, Dr. F. L. Richard (Stafford) : A boy, visiting the Zoo, climbs into the bear pit and is bugged by a bear, but rescued by the keeper. Injuries : Fractured ribs on right side severe lacerations of back, fracture of humerus near elbow joint, shock.

Presentation of prizes to the winning teams -

~~rs.ing Cadet Team Test, judged by Com-

mISSioner. Dr. T. T. Baird (Wales): A girl cyclist wobbles. hits the kerb and falls. Injuries: 'Wound of right arm with severehaemorrhage and F. B. embedded, simple fracture of left leg, abrasions on chin, shock. Ambulance Individual Tests judged by Div. Surgeon James Baker (W. R. , Yorkshire), Area Surgeon R.G. Southern (Surrey) and Area Surgeon, C. J. P. Seceombe (London District): o. 1 finds a linesman \\ho has fallen from a telegraph pole. Injuries: Wound on left cheek, fractures of both feet , shock. os. 2 and 3 are called to attend a night wat<:;hma.t:,l wh~ has been found lying outSIde hiS hut 10 a confused condition. Injur~es: Insulin overdose, wound of scaJp WIth F.B. embedded. o . 4 finds a man who has fallen from a cliff. He is unconscious, '" ith a boulder lying across his left leg. Injuries: Depressed fracture of skull compression, simple fracture of mid left leg. Nurs~g Individual Tests, judged by C.N.O.

MISS P. Lawton, S.R.N. (Stafford), C.N.O. Mrs. r. M. Hoby, S.R. . (Kent) and C. T.O. A. Exell, S.R. . (Isle of Wight): o. 1. is required to demonstrate the prep~r.atlOn. of an enema and explain its adrrumstratlOn. os. 2 and 3 have to demonstrate bedmaking ~or a p~tient with leg in P .O.P. No.4 IS reqmred to tender assistance to a patie~t suffering with an acute nonillfec!lOUS chest affection, jncluding the erectIOn of a steam tent. Cadet Ambulance Individual Tests, judged by County Surgeon, F. H . Vollam (Worcester), Asst. Area Surgeon, J. H. Chambers (London District) and Div. Surgeon, M. Cohen (London District)· o. 1, walking in the country, finds ~

camper \\ ho has fallen whilst carrying a kettle of boiling \ ater. Injuries: Scalds on right hand, prained left ankle. os. 2 and 3 are called to attend a patient who, whilst using an electric drill has received an electric hock. . Injuries: Asphyxia, burns (electric) of fight hand. No: 4 ees a boy tr) ing to open a \\ indo\\. !Ie sllps and crashes through the window IOto the room. Injuries: Wound of left leg, with severe haemorrhage and glass embedded simple fracture of right arm, shock. ' Cadet Nursing Indhidual Tests, judged by C. .0. Mrs. McPherson, S.R. . (Sussex), Area .0 . Miss J . M. Hughes S.R.N. (Norfolk) and rea N.O., F. Wade, S.R. . (London District): . o. I is required to apply a K.P. to a pamful shoulder and bandage it in position. os. 2 and 3 are required to make an occupied b~d, ch~nge top sheet and place bed cradle ill pOSItIOn over lower limbs. o. 4 is required to apply a cold compress to head (headache) and crepe bandage to swollen ankle and leg. . The competitions were under the directIOn of Surgeon-in-Chief, Major A. C W~lte Knox, O.B.E., M.C., M.B., Ch.B., assisted by Deputy Surgeon-in-Chief, M. M. Scott! and Chief ursing Officer, Miss Harrulton-Wedderburn, S. R . . At 3 o'clock all the competing teams assembled at the entrance to the H all to form a guard of honour, and ten minutes later Sir Charles and Lady Torton, Mayor and Mayoress of Westmin ter arrived and were received by Lieut,-Gene;al Sir Henry Pownall, K.c.B. , D.S .O .. M.C. , Chancellor of the Order of St. John; MajorGener~l M. Kirkman, CB., C.B.E., CommissIOner-in-Chief, S.J.A.B. and the Countess Mountbatten of Burma, c.l., C.B.E., D.C. V.O., Superintendent-in-Chief S.J.A.B. ' At 3.15 p.m. Sir John Nott-Bower K.C.V.O., Commissioner of the Metro: politan Police Force, and Lady Nolt-

FIRST AID & NURSTNG, JULY/AUGUST 1957 Bower. arri\ 'e d and were recei\'ed by the Chancellor, the Commissioner-tn-Chief, S.J.A.B., the Superintendent-in-Chief, SJ.A.B. and Major White Knox, Surgeonin-Chief. S.J. .B .. \\ho conducted them to the four main platforms in turn. \\ here they witnessed demonstrations by four team Ambulance: Whitwick Colliery. ursing: Clapham Common. Cadet Ambulance: Fairbairn House. Cadet Nursing: Clapham Common. When the results were announced it '" a seen that the winning team had ceen selected for this honour. Each team demonstrated the test \\ h ich had been set them for competition earlier in the day, whilst Major White Knox maintained a running commentary, explaining the various technical points, after which the judges \\ere introduced to Sir John and Lady ott-Bm er. Whilst the "ast audience was assembling in the Great Hall for the presentation ceremony they were entertained to a recital of organ music by Di v. Superintendent F. E. Clifford (l.ondon District). The chair was occupied by the Commissioner-in-Chief, and he " as supported by Sir John and Lady ott-Bower, the Chancellor of the Order of St. John, the Superintendent-in-Chief. S.J.A. B. , the Mayor and Mayoress of Westminster. the Deputy Commis ioner-in-Chief lReardmiral R. M. Dick, C.B., C.B.E., D .S.C.), tbe Deputy Superintendent-in-Chief (Mrs. B. Grosvanor. CB.E.), the Surgeon-inChief, Col. Goring and the judges, whil t behind them at Mis {orrison . M r. Quilter, Miss Harri son, Mr. \ riggle worth (Director of Store) and Dr. Scott. Opening the proceedings, the chairman aid that it was a great pleasure to him to welcome Sir John and Lady ott-Bower and the Mayor and Mayoress of Westminster. a one would know better than Sir John, who had been a policeman for 45 years, the strong link '" hieh had always exi ted between the Police and the Brigade. Overseas it was often the case that the Commi ioner of Police was also the Brigade Commis ioner, and since he him. elf had been wearing the Brigade uniform he had been asked on two occasion if he were a Commi sioner of Police . . Like the police, however,' he said, ' we shall al\\ay be at the right place at the right time, but if we are to maintain our position, then we must pursue a great recruiting campaign: This was the second occasion upon which the adults and cadets had held their annual competitions at the same time, and he had been delighted to learn from the judges that the standard had been found to be so high -especially by the cadets. He thanked the teams for the enormou amount of hard work which they had put in in order to reach the flnals. He wished, also, to thank the judges who took so great an interest in the movement, and were always so ready to sacrifice their time and skill in this great work. There was one organisation which especially deserved their gratitude. Year after year the Associated British Picture Corporation Ltd., had provided, erected and removed the scenery which made the tests so realistic. He felt that they could never thank this Corporation sufficiently. Then tberewere the' patients' and 'faker'

(make-up artists). all St. John-trained without whose skill the tests would los~ much of their reali m. The stewards, timekeepers and others had had a yer) heavy day, but he had not heard one word of complaint, and all had entered mo t cheerfully into making the event a succe . He believed that what thev were all anxiously waiting for was to hear the re ults, and he asked that the e hould be announced: AMBULANCE I. Whitwick Colliery (Leicester) . .. 3401 (winning the De\var Shield the Hingston Ro e Bowl~ shared-and the Elli Cup) 2. Shrewsbury (Shropshire) ... 333~ (wiruilng the Symon Eccles Cup and the Hingston Ro e Bo\\lshared) 3. Dean and Chapter Colliery (Durham) 321 (winning the Hong Kong Shield) 4. Brighton Pol ice (Sussex) 318 (winning the Trimble Shield) 5. Southampton Police (Hant -.) ... 315 6. Swansea Police (Wale) 3061, 7. Fishponds (Bristol) ... . .. 296~ (winning the Copland-Griffith Cup) 8. Wimbledon and Merton (London) 271 9. Northwich (Che hire) ... .. . 270~ 10. Cambridge City Police (Cambs.) 2661 11. YorkCity(W.R.,York) 249l\T(]RSING 1. Clapham Common (London) .. . (winning the Perro tt Shield, the Chalmers Cup and the Mountgarret Cup) 2. Spalding (Lincoln) (winning the Corbet Fletcher Cup, the Mountbatten Cup. the Ellis Cup and the r..{arguerette Golding Trophy) 3. Birmingham (Telephone House) (winning the Stewart Cup) 4. Blackpool 'B ' (l.ancs.) 5. Letchworth (Herts.) 6. Braunton (Devon) 7. Darlington (Durham) 8. Wetherby (\V. R ., Yorks.) (winning the Gro venor Cup) 9. Tredegar (Wales) 10. Weymouth(Doret) J I. Chertsey (Surrey) 12. Y.W.C.A. Student ( . Treland) CADET A IBULANCE 1. Fairbairn Hou e (London) (winning the White Knox Cup, the Jarvis Cup. the Barne Cup and the New Zealand Cupshared) 2. South Kirkby Colliery (W.R., Yorks.) (winning the Schooling Cup and the ew Zealand Cup--shared) 3. Donisthorpe Colliery (Leicester) (winning the Pownall Cup) 4. Preston (Lanes.) 5. Great Yarmouth (Norfolk) 6. Beaconsfield (Bucks.) 7. Duffryn Aman (Wales) .. , 8. Truro (Cornwall) 9. Ladywood and Edgba ton (Birmingham) .,. (winning the Barne Cup)

302

297!

275~

261 259t 255 254';' 2452-+4.\ 233225 197

254 ~

235~

2341 2251 22221 2191 21 ~ 196~

10. Fi hburn CollIery and Welfare (Durham) .:. ... .. . 11 . \Voodham and Byfleel (Surrey j

1 c 156

CADET ~URS{;,\G ... 3 \4~ (\\ inning the Dunbar-Smith Cup, the Y hite Knox Cup and the Tweedale Cup) . .. 2. Hey ham (Lancs.) ... )14~ (winning the Mountbatten Cup and the Emdon Cup) 3. Brislington (Bri tol) ... ... 295 (winning the Pownall Cup, the Bedmaking Cup and the Cunard Cup) 4. R ye (Sussex) . .. . .. 2 8 5. Peterborough Odeon and Broad\\ ay onhants.) 286 ... 166.\ 6. Letchworth (Hert.) 7. Dar! tngton (Durham) ... 1662·P . St. Peter's (Birmingham) 9. Bletchley (Buck .) ... 24-+ 10. Yslradgynlais (\ ales) ... 240~ 11. Hun let and Holbeck (W. R ., 2ln Yorks.) 12. Ballymena( . Ireland) 214Major White Knox then offered, on behalf of the judges, some most \ aluable comments. 'Tt i m) duty,' he commenced, . to assess the \ alue of these competitions.' He had often wondered at the success of the colliery teams. Could Dr. Scott. who was responsible for that huge pile of marking sheet, thro\\ any light upon thi' question ~ Commenting upon the competitions, he said that he felt sure that any criticisms which were offered \\ ould be accepted as constructive, for they were intended to help the competitors-and. indeed. all who \\ ere interested. high tandard was expected, and the) had been struck by the efficient manner in which the tests had been tackled. There were. ho\\e\"er. man} faults. Many competitor would persist in talking instead of conducting a physical e:\amination of the patient. Diagnosis must be confirmed, but if proper!) carried out it need not have taken many of them a long as it had done. In fact, some had taken so long to diagnose that it had left tbem insufficient time to complete the treatment. Turning to the nurses, he said that he was alwa} impre ed by the standard of bandaging e"hibited by these ladies, which compared Yer} favourabl} \ ith that of profe sional nur'es. He emphasised that if they were to be successful in tbe application of the practical part of nur ing, then it was most e sential that they hould be efficient in their bandaging. fhey must also be efficient in handling equipment. The work of the boy cadets had been excellent, but they mu t learn to work as a team and not a' individuals. The girl cadets deserved special prai e for their outstanding work, both leaders and member'. He concluded by aying.· We have found the standard ,ery high today, but don't be sati fled. Keep on plugging away.' The trophies were then pre ented by Sir John Nott-Bower. In doing ' 0 he expressed his pleasure at being there to perform this senice. He was hon~)U~ed and delighted to recall the long as OClatlOn between tbeSt. John mbulanceBrigadeand the police. He h?ped t~at it would c.on~inue. B~ informed hl audlence that his tather 1. Palmer Green (London)

FIRST ATD & NURSTNG, JULY/AUGUST 1957

6 was High Constable of Liverpool, and that when he first accepted the appointment there were no ambulance arrangements at all. In 1897 the first ambulance services were organised in Liverpool, and the personnel were trained by the st. John Ambulance Association. Later on the first City of London Ambulance Service was established. Although there were now ambulance services serving the whole of the country, there was still plenty of room for the voluntary first aiders, who were doing a grand work. He had been very much impressed by the demonstrations he had seen that afternoon, and also by what he had learned from Major White Knox. 'This competition is the focal point of all the work which has been put in by competitors all over Great

Britain during the past year,' he said. He had been very much impressed by the work of some of the younger competitors, both boys and girls, and he hoped that they would continue to maintain that standard. Finally, he welcomed this opportunity of congratulating their new Commissioner-inChief upon his appointment, and he felt quite sure that he would render them valuable service. He concluded by thanking them for the honour they had conferred upon him by inviting him there that day. Viscountess Mountbatten, Superintendentin-Chief, said, ' It falls to me to thank you, Sir John, for so inspiring an address, and also Lady Nott-Bower. It has, also, been inspiring to realise that it was your father who was the great pioneer in the ambulance service.' She thanked the Mayor and

Mayoress of Westminster for sparing yet another half-day of their valuable time to support this great cause. They all very much appreciated their great interest. She concluded by referring to the spirit of comradeship which existed between the armed forces, the medical and nursing professions, the various ministries of the Crown, the W.V.S. and all those organisations which were working together for the benefit of mankind, but stressed the need for more recruits. Her farewell was a quotation from a popular song: ' See you later, Alligator.' (Cheers and laughter). The great audience rose and, accompanied by the organ, sang the National Anthem. To you, Mr. Quilter, congratulations and thanks.

Ministry of Supply Finals

IT is very gratifying to note the interest

taken in the first aid movement by the various Government departments, and one of the most enthusiastic is the Ministry of Supply. The final first aid competitions of this department were held at the Central Hall, Westminster, for the challenge trophies presented by the St. John Ambulance Association. Eleven teams of men and five of 'homen from all parts of Great Britain took part in keenly-fought contests. THE TESTS

Men's Team Test, judged by Dr. J. T. Daly, of Birmingham: The stage had been made to represent the stokehold of the building, in which the caretaker's mate is found lying unconscious. Injuries: Asphyxia (incomplete combustion), compound fracture of right fibula, simple fracture of right patella. Women's Team Test, judged by Dr. J. Kensall Thomas, of Dunstable: The team is passing a house when a woman rushes out and asks for assistance. Upon entering the house they find a man who, whilst replacing an electric bulb, received an electric shock and fell from the table upon which he had been standing. Injuries: Bruise on forehead, concussion, simple fracture of right forearm, simple fracture of right fibula. Men's Dual Practical Tests, judged by Dr. A. H. Jones, of Highgate: Nos. 1 and 3 are called to attend a man who has fallen from a chair upon which he had been standing. Injuries: Colles' fracture (right), wound in palm. Nos. 2 and 4 are called to an office, where they find a man lying on the floor. Nobody had seen what happened. Injuries: Apoplexy, simple fracture of left clavicle. Women's Dual Practical Tests, judged by Dr. A. Conn, of Ewell: Nos. 1 and 3, walking along a quiet-street see an elderly man in front of them stumbl~ and fall to the ground. Injuries: Fracture of neck of femur graze on left hand. ' Nos. 2 and 4 are called to give assistance to a man who, whilst carrying some dirty crockery in the kitchen, slipped and fell to the floor.

Injuries: Simple fracture of right patella, wound of right forearm, shock. Mr. Horace F. Parshall, T.D., M.A. (Oxon.), Director-General of the St. John Ambulance Association, presided at the presentation ceremony, supported by Mr. Aubrey Jones, Minister of Supply, and Mrs. Jones; Lieut.-General Sir Henry Pownall, K.e.B., K.B.E., D.S.O., M.e., Chancellor of the Order ofSt. John; Major-General W. E. Tyndall,C.B.E.,M.C.,M.B.,D.Ph.,Deputy Director-General, the st. John Ambulance Association, Major-General J. M. Kirkman, e.B., e.B.E., Commissioner-in-Chief, the St. John Ambulance Brigade; LieutCol. J. E. F. Gueritz, M.A. (axon.), Secretary, the St. John Ambulance Association and the judges. Mr. Parshall, in welcoming Mr. and Mrs. Aubrey Jones and the visitors, recalled that Mr. Jones had always taken a very keen interest in the ambulance movement, and he felt sure that this personal interest of the Minister would prove a stimulus to first aiders throughout the Ministry. He would take that opportunity of expressing their gratitude to all those who had worked for the success of the competition. Once again they were indebted to the Associated British Picture Corporation Ltd., who were always so ready to assist by providing and erecting the scenery which lends the realism to competitions today. The stewards, timekeepers, the St. John-trained 'fakers' and 'patients' and all those whom he couLd not mention individually, he asked them to accept their thanks. Then there were the judges, to whom they owed so much, and without whose support these competitions would not be possible. They were the life-blood of the Association. The judges then offered some good practical advice to the competitors. Dr. Daly referred to the lack of observation on the part of some teams, quoting as an instance one competitor who actually sat on the boiler! However, he knew that there were many things done in competition which would not be done in real cases. Dr. Jones complimented the teams upon their excellent technical first aid, but regretted that, in some cases, they showed a complete lack of perspective of the whole picture. He criticised some teams who gave precedence to the fractured clavicle over the apoplexy, pointing out that the patient might have died of the Jatter whilst they were treating the fracture. All had been slow in finding the haemorrhage, but

even then they must remember that pressure must be maintained. The teams were well organised. Dr. Conn referred to one humorous incident which came under his notice. After diagnosing correctly, they then proceeded to treat the wrong limb! Most teams were weak on stretcher drill. Mr. Craft then announced the results: MEN 1. R.R.E., Defford 334t (winning the Championship / Trophy) 2. R.O.F., Cardiff ... 327 3. C.D.E.E., Parton 314~" 4. A.R.D.E., Fort Halstead 309 5. R.O.F., Bishopton 305 6. S.D., Elstow 295~ 7. RoyalArsenalEstate 291t 8. R.O.F., Chorley 272 9. S.D., Melmerby ... 244~ 10. R.O.F., Fazakerley 227i 11. R.O.F., Nottingham 225 Best Pairs Cup: Nos. 1 and 3 of A.R.D.E., Fort Halstead. WOMEN I. St. Giles Court ... 348 (winning the Championship Tropby) 2. R.O.F., Chorley 340 3. R.O.F., Cardiff ... 298:} 4. S.D., Eastriggs ... 262t 5. R.O.F., Nottingham 243 ~~ Best Pairs Cup: Nos. 1 and 3 of St. Giles Court. In presenting the trophies, Mrs. Aubrey Jones said, 'I have been the wife of a minister long enough to know tbat I should be seen and not heard. However, I was delighted to be invited here today, for I have always been interested in this great work.' It was a great thing, she reminded her hearers, to be able to render skilled as'Jistance in emergency. She then gave some startling figures relating to first aid in her husband's Ministry. Since J951, no less than 15,000 casualties had been treated by 1,000 first aiders, and 9,000 certificates had been gained during the same period. Service under the banner of St. John was not merely spectacular, it was practical. She herself had served as a nurse during the war, and she went on to quote one or two cases in which he had been privileged to

FIRST AID & NURSING, JULY/AUGUST 1957 render first aid. She assured her audience that no one appreciated the work of the Director-General and his Association more than her husband and his Ministry. She would like to conclude with a word of appreciation for the work of their Chief Medical Officer and his staff, especially Mr. Bailey, the Ministry'S Training Officer.

Mr. Parshall thanked Mrs. Aubrey Jones, on behalf of all present, for coming there that day to present the trophies, and the presentation to her of a beautiful bouquet brought to a close a most successful event, which had once again been in the capable hands of Mr. George Craft, Competition Secretary to the Association.

National Dock Labour Board Ambulance Centre Competition Finals THOSE who come to witness the finals of this well-known centre have come to look for' something extra,' and they are never disappointed. This year the event took place at Queen Mary College, Whitechapel Road, the competitions being staged in the theatre formerly known as the 'People's Palace,' a building which has been closely I inked with the cultural life of the London dock worker for many years past. Before the competitions commenced we visited the Stern HalJ, where a varied exhibition was being staged for the instruction of first aiders and nurses. On the first stand we saw teaching aids and equipment available to instruction classes organised by the centre. It was at this stand that we learned that 'Firsr Aid & Nursing' is regarded throughout the National Dock Labour Board Ambulance Centre as a most valuable journal, and a huge pile of back numbers had been acquired and were being distributed for the purpose of encouraging more of their members to take it regularly. At the next stand we met some old friends. Tbese were members of the Casualties Union, demonstrating the art of 'making up' patients, and exhibiting the materials used in these skilful operations. Further on we saw a replica of one of the Board's medical centres, in charge of Sisters Freeman and Ridley, from the West India Docks, who extended a cordial invitation to us to visit their medical centre at the docks, an invitation we certaiI!ly hope to accept as soon as the opportull1ty occurs. Next, Dr. Skeoch was explaining physiotherapy and rehabilitation, and demonstrating the treatment of shock. In the centre of the hall demonstrators were describing artificial respiration,. givin.g instruction to visitors, and measunng theIr pressure on a gauge. Uniformed members of the St. John Ambulance Brigade from Liverpool and Hull, and of the St. Andre.w Ambulance Corps from Glasgow were In attendance to answer questions relating to Brigade matters. A magn!ficent display of trophies won by the Liverpool Ce!1 tre crowned the middle of the hall. Films illustrating first aid and nursing were shown at intervals. In a corridor known as 'The Cloisters' was an interesLing exhibition illustrating the evolution of the steamship from the barques of 1830 to vessels of the present day. At first we wondered what this had to do with first aid but it was pointed out to us that it was intended to emphasise the parallel increase in hazards calling for an increased knowledge of first aid. It was now time for us to return to the competitions, which had been divided into two sections, one for staff and one for dock workers.

Staff Team Test, judged by S. Hulme, Esq., M.B., B.S.: A laboratory assistant is discovered unconscious in the laboratory following an explosion. Ammonia fumes fill the room. Injuries: Asphyxia (ammonia), ammonia burns of left hand, wounds on right cheek, with glass embedded, simple fracture of right clavicle. Dock Workers' Team Test, judged by J. H. Chambers, Esq., M.B., Ch.B., DJ.H.: The set represents the hold of a ship, where a docker is found to have slipped from a ladder, falling across some cased goods. Injuries: Simple fracture of 5th and 6th ribs, wound on right forearm, with severe haemorrhage, Potts' fracture (left). Staff Dual Practical Tests, judged by E. J. Selby, Esq., O.B.E., M.A., M.R.e.S., L.R.C.P.: Nos. 1 and 3 find a man, who has been drilling a piece of wood. The wood has jammed on the drill, swung upwards, and struck him on the jaw. Injuries: Fracture of jaw, slight concussion. Nos. 2 and 4 find a man who has tripped and fallen to the floor. Injuries: Dislocation of left elbow, injl1"y to liver. Dock Workers' Dual Practical Tests, judged by Lancelot K. Wills, Esq., M.A. M.B., B.Ch.: Nos. 1 and 3 see a painter accidentally burned by his blow lamp, and in jumping aside, he stumbles.. . Injuries: Burns on nght leg, spralOed right ankle. Nos. 2 and 4 witness a collision between two men, one falling to the ground, the other disappearing' to find a doctor.' He does not return. Tnjuries: Fracture of right patella, nerve shock. During an interval following the competitions the platform had been prepared for the presentation ceremony, the l~ng table concealed under a huge cover bearmg the emblems of the St. John Ambulance Association, the St. Andrew's Ambulance Corps and the National Dock Labour Board. In front were exhibited the trophies. . The chair was occupied by the Rt. Hon. Lord Crook, K.St.J., J.P., Presi.dent of the centre, who was supported by M a.JOr-General W. E. Tyndall, C.B.E., M.C., M.B., D.Ph., Deputy Director-General, the ~t. John Ambulance Association; Arthur BIrd, Esq., Chairman of the Centre; Lieut-Col. J. E. F. Gueritz, M.A. (Oxon.), Sec!,et.ary, the St. John Ambulance ASSOCIatIOn; George Craft, Esq., Competition Secretary,

7 the St. John Ambulance Association and D. J. Hallard, Esq., Competition Secretary, N.D.L.B. The Chairman, in opening, said that it was his sad duty to convey the apologies of Horace F. Parshall, Esq., T.D., M.A. (axon.), Director-General of the St. John Ambulance Association, who had just suffered a bereavement and was attending a family funeral. Be was sure that they would all wish him to convey the sympathy of the gathering. Lord Crook then went on to say that it had been a great day for the Centre, and the event had been held in excellent surroundings . He reviewed the progress which had been made in the N.D.L.B. during the past six years, including the provision of medical centres in the docks, in charge of State Registered Nurses, and with a medical officer in charge. 'Do we, therefore, require first aiders?' he asked. Answering his own question, he said, with great vigour, 'Yes, by all means. The immediate attention on the spot by a skilled first aider often meant the difference between life and death, or, at least, permanent incapacity.' In fact, he went on to say, they needed more and more of these voluntary workers who were prepared to give time and study in the service of their fellow man. He said that it was competitions of this kind which helped them in their recruiting. Major-General Tyndall said, ' To me it is a very great pleasure to speak to you upon several points. He agreed with the Chairman in that competitions stimulated both interest and recruiting, as well as exerting an important effect upon the ind~vidual. In competition he learned to apprecIate the problem before him. He had been studying the reports for last year, and. had fo~nd the analyses of marks very Illterestlllg. Sometimes a team had lost by one mark. The resolve of every competitor should be: , I will not give away that one mark.' The work of the last five years had been very encouraging. 30 first aid branches had been formed, as well as 15 first aid rooms, and 29 instruction classes had been established. He thought it a most commendable effort. 'I was a ship's surgeon for five years,' he told his audience, ' so I have had some experience in this class of work.' No one appreciated more than he the importance of properly trained personnel. He felt that a great step forward had been the production of a standard text book embodying the teachings of St. John, St. Andrew's and the British Red Cross Society, and he hoped that it would be available by the end of th<? yea~ .. They contemplated extendi ng theIr tralOlOg t~ agriculture, the Boy Scout and the Boys Club movements. He also drew the attention of his hearers to the new text book on ' Occupational First Aid.' He was followed by Lieut.-Col. Gueritz, who stated that he was deputising for Major White Knox, Principal Medi~al Officer, the St. John Ambulance As~ocla tion who sent his apologies for unaVOIdable abs~nce. Col. Gueritz reminded his .h~ar ers of the great expansion of the ASSOCIatIOn and its work allover the world, and the fact that their official text books were being translated into many languages and classes established throughout, 11:ot only the colonies, b~lt foreign countnes. He

FIRST AID & NURSING, JULY/AUGUST 1957

thanked the N.D.L.B. and all present for their continued support of the Association. Dr. Chambers commented on behalf of all the judges, so that his remarks were rather of a general character. It was the first time he had had the pleasure of judging the N.D.L.B. competitions, and he was pleased to see the enthusiasm exhibited, both by the teams and by the spectators. Dr. Wills had asked him to stress one point, and that was, in treatment of shock the weather conditions should be taken into consideration before deciding whether or not to cover the patient. That day they had worked under a blazing sun, yet some teams had covered the patient with blankets! There had been cases in which the patient had been moved before the extent of the injuries had been assessed. Again, it was just as necessary to consider what NOT to do as what to do. The team test had reaUy been a simple one, and everything needed had been placed near at hand, if only they had used their eyes. Sometimes over-enthusiasm had resulted in work which could only be described as 'rough.' For instance, the competitor who grasped the leg of his patient and wiggled it about. Some seemed to like working in a muddle instead of moving obstacles which were in the way. The man had fallen from a ladder. What were the probable injuries? They should always suspect a back injury. They had seen that old fault-bandages not tight enough. In fact, he saw one which did not even hold the splint at all. All did not turn the patient on his side. There is a definite reason for turning the patient on his side, otherwise it would not be in the book. Altogether, however, the teams had done well-especially in that hot weather (the temperature had been in the upper 80's). The results were then announced by Mr. F. G. Thomas, M.A., Secretary of the Centre: STAFF 1. Liverpool (winning the Trophy) 2. London ... 3. Head Office 4. Newcastle 5. Middlesbrough

3]7 Championsh'ip

DOCK WORKERS 1. Grimsby No.2... ... ... (winning the Championship Trophy) 2. London Upper Pool 3. Yarmouth 4. Swansea 5. Grimsby No.1 6. Middlesbrough 7. Liverpool 8. Southampton 9. Greenock ] O. Grangemouth 11. Blyth '" 12. Aberdeen

303 277t

242t 2261 336 322 293 288 279 267t 264t 263 240 238 228 177

.Before presenting the trophies to the wmnmg teams, the Chairman said that he had a very pleasant duty to perform. He had been asked to present, on behalf of the Order of S.t. John. the badge of Hon . Life MembershIP. of St. John to Mr. David Hallar<;i,. theIr Competition Secretary, in reCO~l11tlOn of all that he hSld done for this

great movement. Mr. Hal lard sui1.ably replied. The trophies were then presented by Lord Crook. Mr. Morris Gifford, M.A., had a word for the competitors, especially those who had not won a trophy. They must not regard themselves as failures, but must try again next year with renewed effort. He thanked the St. John Ambulance Association for the splendid work they were doing, . mentioning particularly Mr. Parshall, Lt.Col. Gueritz and Mr. George Craft. Incidentally, he wondered if they all knew that their beloved President, Lord Crook, had been elected a Member of the Chapter of the Order of St. John. He felt that this honour reflected upon the N.D.L.B. as a whole. He had always been impressed with the skill of the members of the Casualties Union in 'making up' patients so realistically, and they were most grateful to those members of the Union who had come there that day to assist them, both in 'making up' and in the exhibition. He

thanked the Administrators of the University of London and Queen Mary College for having placed tbat magnincent building at their service, and also the various medical officers and nurses from the various hospitals who had so kindly given their services. There were many others he would like to thank, bu1. he must confine himself to two further names. The judges who were always so ready and willing to sacrifice their time and skill in this great cause, and the Associated British Picture Corporation Ltd., who had so kindly supplied the scenery for the various sets. Thanks to Lord Crook for his great interest, and for presiding at that gathering brought to a close a most enjoyable and successful event, which had been in the capable hands of Messrs. George Craft and David Hallard. Note.-It may not be generally known, but in chatting with Lord Crook on a former occasion, he told lIS that he had himself held a first aid certificate for many years. Hence his unqual ified enthusiasm in this work.

B.T.C. (Railways & Docks) and B.T.C. Police

N0 less than 26 teams entered for the

finals in these competitions, and with six tests being conducted simultaneously, Mr. George Craft, the well-known S.J.A.A. Competition Secretary, is to be congratulated upon being only five minutes behind scheduled time by the end of the afternoon. There were, as usual, both team tests and dual practical tests. Team Test for Railwaymen, judged by G. M. Shaw Smith, Esq., M.B., Ch.B., D.P.H., of London: The team find a man lying on a trolley. A heavy sack, which has fallen from a faultily-built stack, is on top of him. Injuries: Contusion on head, concussion dislocated right shoulder, crushed ribs' compound fracture of right leg. ' Team Test for Railway women and B.T.C. Police, judged by J. Trefor Watkins, Esq., B.Sc., M.B., Ch.B., of Nottingham: A hot water boiler has burst in the station refreshment room. The team find the victim lying on the floor. Injuries: Multiple scalds of head, chest and neck, concussion, simple fracture of right femur. Du~l

Practical Tests for Railwaymen, Judged by Charles Sharp, Esq., M.B., Cb.B., of Liverpool and J. J. Morland Esq., M.B., B.Ch., of Tadley: ' Nos. 1 and 3 are called to give assistance to a drayman who has slipped whilst carrying a crate of bottles. Injuries: Simple fractures of 5th 6th and 7th right ribs, wound of thu~b with arterial haemorrhage, shock. Nos. 2 and 4 are asked to give assistance to a passenger who, in trying to alight from a moving train, has fallen heavily to .the ground. Injuries: Simple fracture of humerus upper third, deep gash on right leg, shock: Dual Practical Tests for Railway women and E.T.C. Police, judged by S. E.

Jackson, Esq., M.B., Ch.B., of Scarborough, and Miss Olive S. May, M.R.C.S., L.R.C.P., of London: Nos. 1 and 3 are called to give assistance to a woman who has fallen over the curb of a fireplace and is lying on the floor holding her left wrist. Injuries: Slight concussion, Colles' fracture (left). Nos. 2 and 4 see a car collide with a cyclist, who falls to the ground. Injuries: Compound fracture inner side of right leg, simple fracture of'metacapels of right index and long fingers, shock. Major A. C. White Knox, O.B.E., M.C. M.B., Ch.B., Principal Medical Officer of the St. John Ambulance Association presided at the presentat~on ceremony, and he was supported by SIT John Benstead, C.B.E., Deputy Chairman, British Transport Commission; Major-General J. M. Kirkman, c.B., C.B.E., Commissioner-inChi~f, the St. John Ambulance Brigade; Major-General W. E. Tyndall,C.B.E.,M.C., M.B., D.Ph., Deputy-Director-General, the St. John Ambulance Association' Mr George Craft, Competition Secretary, theSt: John Ambulance Association, and the judges. Opening the proceedings, Major White Knox apologised for the absence of the Director-General of the Association, Mr. Horace F. Parshall, T.D., M.A. (Oxon.), who had been called away on urgent business, adding, 'I feel that I am an Iln,:"orthy substitute.' They were, he said, delIghted to have with them Sir John Benstead, who had always shown a great interest in the first aid movement and who had so kindly consented to p;esent the trophies. He also extended to all the other heads of departments a cordial welcome on behalf of the Association. Year after year the Associated British Picture Corporation Ltd., had proved a most. v.aluable friend. of the Association by provldmg and erectmg the scenery which made the tests so natural) and this nat\lral

FIRST AID & NURSING, JULY/AUGUST 1957 setting was completed by the skill of the St. John-trained ' fakers' who made up the 'patients,' all of whom deserved their heart-felt thanks. He thanked the stewards, timekeepers and all who had contributed to the success or the competition. Last of all he referred to the judges, those professional ladies and gentlemen who were always so ready to give of their time and skill in this great cause. Referring to the competition tests, Major White Knox said that the standard appeared to be well up, but they would hear more about that from the judges, who would be asked to make their comments. Dr. Shaw Smith, who said that he was also speaking for Dr. Sharp, commenced by stating that there bad been little that he could criticise, and those criticisms which he did offer were chiefly of smail points. He again called attention to slack bandaging which failed to give the support required. In some cases the work had been hurried , and there had been considerable 'dodging about.' There had been a tendency to- rush. There had been the usual failure to observe any further potential danger. He also reminded competitors that they could not examine a patient thoroughly whilst lying on his face, although they must not omit to examine the back. Tying the feet assisted in immobilising the lower limbs. He had noted a tendency to devote attention to minor injuries at the expense of major ones. Some competitors looked for things that were not there. Removal of jacket was not good. However, on the whole the standard had been good, and he congratulated all, both winners and losers. Dr. Shaw Smith was followed by Dr. Watkins, who said that he was also speaking for Drs. Jackson and May. Many of the teams, he commented, had failed to immobilise the injured limb as early as they might have done, whilst others had failed to ensure that there was no possibility of further danger. He agreed with Dr. Shaw Smith that the standard had been high, but -he did not I ike making comparisons-he had to admit that the standard was higher amongst the women than the men. The care and gentleness displayed by the women had been lacking in the work of the men, who appeared to exhibit anxiety to finish on time. Generally speaking, the pattern of examination of the patient had been inadequate. There had been a tendency to jump from phase to phase of the test instead of working to a plan. A great deal of talking to the judge was unnecessary. He concluded by thanking all who had helped to make their task so much easier. The results were announced by the Deputy Director-General : MEN 1. Southern (Exmouth Junction M.P. No.1) (wi nning the Chal1enge Shield) 2. London Midland (St. Pancras Goods) (wi nning the Corbet Fletcher Cup) 3. Western (Bristol f 3. S~'t~~~~O')(South~mpto'~ Docks S.M.E. No. 1) 5. Eastern (Worksop) (5, Western (Swindon 'B')

543 5281

tied 487) 480~

470

7. London Midland (Camden) 466~ 8. North Eastern (Darlington) 459 9. Eastern (Parkeston Quay) 448 10. London Transport (Lotts Road) 426 11. North Eastern (Newcastle Central) .. 416~ ]2. Scottish (Motherwell) ... 412i 13. Scottish (Edinburgh Waverley) 376~ WOMEN ]. Western (Newton Abbot) 496 (winning the Burrows Rose Bowl) 486 2. North Eastern (Hull) 3. London Transport (Baker Street) 476 4. Southern (Eastleigh Accounts) 440 5. Eastern (Liverpool Street) .. . 409 6. London Midland (Euston 'B') .. . 4044 3"35 7. Scottish (Falkirk) RT.C. POLICE 1. South Western (Dover Marine) 500~ (winning the Sir Bertram Ford Challenge Shield) 2. London (Liverpool Street 'A') .. 496 (winning the Chiefs of Police Cup) 3. Scottish (Edinburgh) 4. Midland (Heysham) 5. Eastern (Nottingham) 6. Northern (Newcastle)

Before presenting the trophies Sir John said that he felt it a privilege to be there that day, but explained that he had been asked to deputise for Sir Brian Robertson, for whose absence he apologised. He was very proud of the fact that he had been connected with the movement for many years, during which time he had noted with pleasure the growing strength of the movement in the British Transport Commission. They now had 20,000 qualified first aiders, and last year 3,000 new certificates had been issued. This was surely a tribute to the work of the St. John Ambulance Association, a classical example of voluntary work. We were living in an age of speed, and the risk of danger increased daily. Accidents may occur at any moment, and it was then that the value of the qualified first aider was appreciated. Prompt first aid, he said, often means the difference between life and death. He was pleased to see the increasing interest taken in the work by the ladies. 'I shall have very great pleasure in presenting these trophies to the winners,' he concluded. Major White Knox thanked Sir John for his long and continued interest in the \>.ork.

National Road Passenger Transport Ambulance Association THE gigantic garage at Aldenham, Herts., which houses the London Transport works, and which, on any other day of the year, would be found packed with 'buses under repair, was transformed mto a vast arena for the finals of the National Road Passenger Ambulance Association, which was held under the auspices of the St. John Ambulance Association in conjunction with the London Transport Ambulance Centre. Despite the fact that Aldenbam is a dozen miles out of London the vast arena was filled with spectators, certain evidence of the enthusiasm which always follows any ambulance event associated with London Transport. Once again the tests had all been arranged in a star-shaped set in the centre of the building instead of each test being arranged in a separate room. These tests were. as usual, of an interesting character.

Men's Team Test, judged by Dr. L. K. Wills: This had a circus flavour. A woman, practising her tight-rope act, falls to the ground. Her small son , hurr~ing. to her assistance, slips with a tumbler In hIS hand . Injuries: (a) Compound fracture of right tibia wound on side of face , slight haemorrh~ge, dislocated right shoulder, shock. (b) Wound (glass) in palm of hand . Women's Team Test, judged by Dr. J. C. Graham: The team find a woman who, they learn, is an epileptic, lying on the floor. In falling she had struck both the table and the leg of a chair. Injuries: Epilepsy, fracture o.f lower j.aw, concussion, simple fracture of Tight claVIcle, sprained right ankle.

on FIRST AID 1. 2. 3. 4. 5. 6.

7_ S.

When do the first-aiders responsibilities end? If a patient is unconscious what is the first thing you note? If the caLIse of an accident is still active what should you do? 1£ there is any doubt as to whether a person is dead or is still alive \'v'ould you abandon treatment? What is the human body moulded upon? Into how many groups are the bones of the skull arranged, and what are they? How many bones are there in the spine? Give the number in each group. Are the ribs bony throughout their entire length? Answers on page 16

10 Dual Practical Tests (for men and women), judged by Drs . R. Renwick and A. H. Jones: Nos. I and 2 see a man cutting a hedge, when he suddenly falls to the ground with the shears in h is hand . Injuries: Wound of right palm (entry and exit), fracture of right forearm, shock. Nos. 3 and 4 see a 'smash and grab' incident, in which a bystander is knocI<:ed down by the thief (who escapes) and sustams injuries. Injuries: Fracture of right patella, dislocated elbow, shock. There were also ora l tests consisting of questions based upon the official St. John and St. Andrew's text books. These were judged by Drs . E. W. Tapley and M. Cohen. After the conclusion of the tests the guests, numbering over 500 we learn, were in vited to take tea with the organisers, when the trophies were presented to the successful teams. The chair was occupied by Mr. J. B. Burnell, C.B.E., President of the N .R .P.T. Ambulance Associ ation , and he was supported by Mr. Horace F. Parshall , T.D., M.A. (Oxon.), Director-General of the St. John Ambulance Association; Mr. Alex J. Webb, M.1nst.T., Chairman of London Transport Ambulance Centre; Dr. L. G. Norman, Vice-President of London Transport Ambulance Centre, the judges and many others. Mr. Burnell opened by expressing his pleasure at seeing so large and representative a gathering there, a nd he hoped that they had had an enjoyable day. The next speaker, Mr. Parshall, was a man they all knew, for he had taken an active interest in the work for many years. He understood that it hap pened to be Mr. Parshall 's birthday-his 34th he believed!-(laughter), and he hoped that Mr. Parshall would carry away pleasant memories of this birthday. Need it be said that this evoked from the audience a spontaneous response in the form of communi ty singing of' Happy Birthday to You'? Mr. Parshall thanked them for their kind wishes, and confirmed that he would certainly have reason to remember 'my 34th birthday ' (renewed laughter). He then continued seriously, and commented upon the work of the National Road Passenger Transport Ambulance Association. 'We in the St. John Ambulance Association,' he said, 'are tremendously encouraged by the work of your organisation, and the high standard which we have witnessed today. We thank you for all that you do, and we shall always be pleased to do all we can for you.' He was followed by the 'judges, who commented upon the tests that had been set for the competitors. Dr. Wills was the first speaker, and stated that they had found the standard well above the average, despite the fact that he admitted that the judges had been hard taskmasters . There were, however, one or two suggestions that he would like to put to them. It would be well if some of them devoted a little time to studying the method of arresting haemorrhage. Many did not take into consideration that it was a hot day when they proceeded to adopt the usual methods of 'keeping the patient warm. ' He also referred to some of the things the competitors told the judge. 'Don't say you are going to do one thing and do another,' he emphasised. 'If you say you

FIRST AID & NURSING, JULY/AUGUST 1957 are going to do a thing, do it.' He congratulated all the teams upon the excellence of their work, and concluded by th 4 nking the managehlent and all who had made the task of the judges so mLlch easier. Dr. Graham followed, and commenced by congratulating the St. John-traincd 'patients' and 'fakers' upon the part they had played. The 'patients' had acted their parts well. Passing on to the work of the teams, he endorsed the comments of Dr. Wills upon the interpretation of the text books on 'keeping the patient warm.' They must always take into consideration the state of the weather and use commonsense. This was a major competition, and they expected a high standard, and it was with this in mind that the tests had been devised. The teams, however, had tackled them well. He had been impressed with the cool approach of most of the teams, but the great thing to remember was that they must diagnose a case before they could treat it. Epilepsy required more study, and it was important to go into this in some detail to enable them to decide whether the case before them was a pure accident or the result of an epileptic fit. In the case that day he criticised the action of some of the teams in putting the patient on the bed, from which he might have rolled off before he fully recovered from his fit. Altogether the teams had worked well. Alderman S. Port, of Liverpool, proposed a vote of thanks to Mr. Burnell for the stimulating influence he exerted in the movement, and also the judges who, despite the many calls upon their time, were always so ready to help. He knew that they regarded it as a pleasure. This was seconded by Mr. D. P. e. Fletcher, Treasurer of the N.R.P.T. Ambulance Association. They also wished to include in their vote of thanks all who had helped to make the day a success, but mentioned especially Mr. H. D. Lewis, of Wales, the Hon. Secretary of the N.R.P.T. Ambulance Association. Mr. J. Henderson, of Edinburgh, replied on behalf of the visitors, and thanked London Transport for their hospitality, and also the catering staff for the part they had played. The Chairman then invited Mr. George Craft, the S.l.A.A. Competition Secretary, to announce the results:

MEN 1. London Transport (winning the Sti rk Trophy) 2. Liverpool 3. Birmingham 4. Edinburgh 5. Leicester ... 6. Huddersfield

482

• From a seat In the alldienee

469~

Some Random (and Provocative) Comments on the Competitions

42It 416 406 404

WOMEN

1. Liverpool

449t

(winning the Lewis Cup) 2. London . . . 3. Cardiff .. . 4. Coventry

398 356 283

Mr. Burnell, before presenting the trophies, said how pleased he was to see so many faces from all parts of Great Britain. Perhaps there was no form of i nd ustry which lends itself more readily to ambulance work than that of transport, and especially passenger transport. In their organisation there was a rapidly growing interest in the subject of first aid, and this was confirmed by a study of the numbers of attendances at lectures. In 1950 there were 13,000, whilst last year this figure had increased to 24,000. Surely this was an achievement to be proud of. They were, however, anxious to widen the field, and to bring in other undertakings who would follow their example. He finished on a personal note, expressing his pleasure that their own women's team, London Transport although they had missed it this year, had won the Lewis Cup five years in succession. Dr. Norman, in thanking Mr. Burnell for having presented the trophies, introduced a personal note by referring to the fact that Ald. Port had come from Liverpool to witness the prowess of his two teams. The ladies were first in their section and the men were second in a larger entry. He should be a very proud man. Ald. Port replied by reminding them that the following week they would be celebrating the 750th anniversary of the granting of the Charter to Liverpool Corporation, and the record of these two successes would be an added attraction to the celebrations. The event was a great success-but could it have been otherwise when the arrangements had been carried out jointly by those two capable organisers, Messrs. George Craft and S. W. Harden?

N .H.S.R. Challenge Cup THE team entered by the Rochdale and District Hospital Management Committee were the winners of the National final in Cardiff on Saturday, July 20th, of the national competition between mobile first aid units of the National Hospital Service Reserve for the Minister of Health's Challenge Cup. They represented all hospital regions of England and Wales. The runners-up were St. Tydfil's Hospital, Merthyr Tydfil, South Wales, who were last year's winners. The other two finalists were teams from Nottingham No.2 H .M.C. and Darlington and Northallerton Operational Group. Nearly 200 teams had taken part in eliminating and regional rounds of this annual national competition. The 14 regional winners contested the semi-final round in Cardiff in the morning and the four resulting winners competed in the final in the afternoon. The test in the final

FIRST AID & NURSING, JULY/AUGUST 1957

was a stiff one, each team having to deal in all with 48 casualties, including 10 serious stretcher cases in the course of half an hour. The judges in the final were MajorGeneral W . R. Dimond, C.LE., C.B.E., I.S.M. (Retd.), a medical officer of the Ministry of Health, Dame Elizabeth Cockayne, D .B.E., S.R.N., S.e.N., Chief Nursing Officer of the Ministry of Health, and Colonel E. H. P. Lasseu, D.S.O., R.A.M.S. The members of the winning Rochdale team were:Dr. G. P. Walker, M.B., Ch.B., D.R.e.O.G., Mr. E. O'Caliaghan, S.R.N., Nurse Tutor, Mrs. D. Drewry, Miss C. M. Howarth, Miss 1. Lloyd, J. Mills. Mrs. L. Russell, Mrs. M. Smith, Mrs. E. Speak, Mrs . S. E. D. Tomlinson. Reserves:- Mrs. A. Broderick, Mrs. E. Matthews, and Mrs. K. Simpson.

B.T.C. (R. & D.) & B.T.C.P. 'Study the comfort of the patient' (text book). Some of the positions we saw were appalling. , Any irregularities, foreign bodies, etc. ?' Judges should refuse to answer. No one noticed the discomfort of the patient, whose legs were hanging over the side of the truck. . Was it necessary to reverse the stretcher three times before loading? Turn the patient towards you, not away from you. 'Bedside manner' varied between the two extremes. , Can you move your leg?' She herself was moving the patient's leg. What a mask (burn)! Poor devil! How seldom we see the h.w.b. covered . . I t's no use trying to stuff padding between the legs after bandaging has been completed. Don't forget that if a patient is conscious he can talk. , How long has this heavy sack been on top of him?' What the devil does that matter. Get if off. If vessels really contained fluid they would be treated with greater respect. The metacarpels perplexed some. Two girls treated ' testing stretcher' as a game. If there's a man about, make use of him, ladies. Surely the need for immediate removal of the sack was obvious. Judges are not impressed by your , playing to the gallery.' . A recital of all the bones 10 the body does not constitute diagnosis. Don't forget to empty hip an.d tr,?users pockets , otherwise that bandage IS go1Og to be pretty uncomfortable. She appeared to enjoy being nursed by the 'copper.' Some of those' sterile' masks had more than a few germs on them. Why all those melodramatic attitudes upon entry? . We like to see the lady Judges. Antiseptic by all means, but don't drown the wound. Haven't you been taught not to use the c. and c. for a Colles' fracture? It is not necessary to tell the judge what you are NOT doing.

Road Passenger

That dressing was far from sterJle after being mauled as it had been . Why are cups of tea persistently placed on the ground? Don't use bandages for sweeping the floor. Brooms are provided for this purpose. In fractured patella limb must be elevated FIRST. 'Is this cup supposed to be empty or full?' . Two Jady competitors walked, on -.ylth their arms around each others waists. Was this for mutual support? Application of a 'barrel' in the supine position had one team completely beaten. One nursing team had only one watch between them.

Were three necessary to attend a boy with a cut hand? What a mess some of them left the room in.

Ministry of Supply There was a tendency to get down to treatment before diagnosis had been completed. Far to') many questions instead of physical examination. We must again criticise removal of clothing . This is a simple operation when the correct technique is adopted. Fancy covering the patient in a boiler room! There was panic when they eventually discovered 'no breathing.' A.R. had been in operation for three minutes before it occurred to someone to remove the patient's dentures. Judges should not admit ' breathing restored' too soon. Several teams were obviously working with their eyes on the clock. Women are now developing that habit of removing the jacket on entry. This habit of the men has always intrigued us. Were two lifts necessary, first on to the sofa then on to the stretcher? Why move the sofa? It wasn't in the way. Many teams knew their work but did not talk to the patient. Documentation was often overlooked. More than one team mistook concussion for shock. Smelling salts are not used as o:ten as they might be. If a team gets into difficulty it must find its own solution. The judge should not help-even if it be a ladies' team! . If the chair is 1n the way, move It. What's the use of a cup of tea to a patient upon whom A.R. is being performed? We have yet to see the team with a perfectly natural approach. Phone message: ' . . . in the office here.' Well where on earth is the office? 'I'don't know anything about first aid, but I can get a glass of water.' . Stretcher drill was well carned out by some teams, but was incorrect i~ de~ail. Ambulance should not arnve If not called. N.D.L.B. Competitors must differentiate between the three types of shock. , We 'll get him off these steps '-but they didn ' t. If that patella wasn't fractured be~ore they started, 1 guess. it was by the tIme they'd finished with hIm. . There is, invariably, confUSIon over the order of treatment for f~actured patella. , 'I note that there IS no dampness. Imagination goes a long way. ?' Bystander: ' Shalll get some tea. No, not before you receive a request by the team. f . We have seen many methods 0 test1O.g stretcher, but have never before seen It jumped upon!

The jug had just been kicked over, but it sti ll produced water! The curtain should not have been lowered before the judge had completed his examination of the bandaging. Congratulations to the patient with fractured jaw for excellent acting. 'Are there any obnoxious smells?' The. air simply reeked with ammonia. Too many unnecessary preliminaries before commencing A.R. For goodness' sake try to judge correctly the length of a second. (A.R.) H.N. and Schafer MUST synchronise. 'Loosen all tight clothing.' The test was nearly finished. Judges should insist upon a more thorough physical examination. Too much is taken for granted. That parrot-like reiteration of 'Don't worry' becomes less and less convincing. You can't take a pulse in ten seconds. Those minute bits of cotton wool between the ankles again! One team consisted of four leaders. 'Don't start rushing me about.' That sounded remarkably like our Fred. Was all that shouting necessary, even if it were in a ship's hold? Every experienced team knows that the doctor will be ' out on his rounds.' Dewar and Perrott Were three nurses necessary to remove the crockery, leaving one to deal with the patient? Women do not think of summoning the ambulance as soon as men. Remove obstacles by all means, but a great deal of time was wasted by the un necessary remo\al of furniture. What a long time elapsed before someone thought about hot tea. One boy went to help the poor bear. Not all thought to ensure that the bear had been safely secured. We saw some excellent performances by both ambulance and nursing cadets. We have visited many zoos but have never before heard sounds like that from a bear. Cadets made good use of bystanders, giving instructions clearly. On the whole blanketing technique was good, but stretcher drill needs more practice. Cadets must learn to talk to the patient. Full length of stretcher must be tested, not just the ends . . Much time would be saved If every member knew thoroughly the arrangement of the haversack. A patient, sitting up in bed during bed making, must be supported. . Plaster should have been lilspected before completing bed making. That screen in the corner made the steam tent too easy. We would like to have seen a stiffer test for ingenuity. . Surely tbe boulder on hIS leg was obviously crying out for removal. ... A gas ring won't heat a saucepan If It IS not lighted. Who knocked the Challenge Cup over? The photographer. . That shield nearly obliterated our Mary.

FIRST AID & NURSING, JULY/AUGUST 1957

Corresponde"ce THE EDITOR.

Hay Fever in Newfoundland

Compiled by W. A. Potter

Literature available to members oI tfle Medical and allied professions only.

Artificial Respiration Dear Dr. BeIilios. With reference to your answer in the May /June 1957 edition of First Aid & Nursing regarding the position of the operator when turning a patient into position preparatory to commencing the Holger-Nielson method of artificial respiration, up to the time of reading your answer, the members of my division were of the opinion that the position at right angles to the patient's body, was the correct one. However, since trying your position, which, as you say, is slightly to the right of the centre line of the pati~nt, we all heartily agree that this is indeed, the best position. Yours faithfully, A. D. HANCOCK, Dip. Supt., Hors/orth Ambulance Division.

'Atlas of Injury,' Part One, described by Casualties Union, 316 Vauxhall Bridge Road, London, S.W.1. Price 2/-. THERE has been a considerable increase in the interest shown in realism in first aid, rescue and nursing training during the post war years. Casualties Union has resisted many requests from its own members and others for a publication containing coloured photographs, because these might lead to stereotyping of injuries and concentration upon the appearance of wounds and other visible signs of damage, rather than on the condition of persons suffering from them, for the most part expressed by their behaviour. Casualties Union is fully aware of the need for word pictures of all the injury conditions, and the Atlas of Injury is an acceptable way of meeting the demand. Instructors training members to act as casualties will welcome it, and the casualties will value it as a book of reference. It will go a long way towards simplifying the writings of briefings. Care bas been taken to set out the information in the order which doctors and orga,oiser.s might find useful when planning a SItuatIOn for a competition-Cause, Form, Make-up and Acting. It does not presume ~o describe an unalterable pattern of behavIOur for tbe patient, but indicates the alternatives, and the way the behaviour might develop.

* First-Aiders Crossword No. 29

Dear Sir, Re your' Do You Know That' in the May lJune issue of First Aid & Nursing, 'The population of Newfoundland enjoy complete immunity from hay fever.' I showed this to my sister-in-law, a native of Newfoundland, and she infom1s me in no uncertain terms that four-fifths of the population do suffer from hay fever and she herself is a victim of pellonitis and her own doctor has spent pounds on trying to cure himself of hay fever! Yours faithfully, L. J. EVANS. 'Westwood,' 74 Hazelhurst Road , Worsley.

Book Review

FIRST AiD & NURSING, JULY/AUGUST 1957

Local Superficial Anmsthesia NESTOSYL Ointment

NESTOSYL Oily Solution

readily accessible mucous membrane.

For treatment of the mucous membrane, particularly of the urinary organs.

NESTOSYL Suppositories

NESTOSYL Ovules

o For lesions of the skin and ACROSS Tobacco container indicates position of scaphoid... . . . (5,3) 5. On the back by drink in a way (6) 9. Diagnostic test in enteric fever (5) 10. Discerned a tangle and withdrew (9) 12. May be contributary to varicose veins ... (7) 13. Awake in the midst of complaints (7) 15. Bodily build ... (8) 17. Often heard before Christmas (5) 19. Birds to clear the throat? (5) 21. Liver tan in the rest period (8) 24. Current of air for medicine (7) 25. A function of the semicircular canals (7) 26. His disease affects the tibial tubercle (9) 27. Capitaifor plaster (5) 28. Embrace perhaps scares (6) 29. Humble, but always in a tear (8) 1.

1. 2. 3. 4. 6.

7. 8. 11. ]4. 16. ] 8. 20. 22. 23. 25. 26.

DOWN Disposal a public health affair (6) UnwelJ and a little depressed ... (5,3,7) Absorbent earth (7) Root for perfume (5) International organisation I form for public duty .. . (7) Health leader at work .. . . .. (l0, 5) (3) Purpose Gets men for the section (7) Eye condition seen in chest yesterday (4) Quiet about testament for nve (7) Gashed without anaesthesia ... (4) Indications might be in glass ... (7) A disappointment in convalescence ... (7) Take ease in a race for crockery (3, 3) Carried in womb or neck (5) Hernial pouch ... (3)

pruritus and inflamed o ·For conditions of the ano-rectal mucous membrane.

NON·TOXIC

NON-IRRITANT

F or treatment of the mucous membrane of the female genital organs.

CONTAINS NO COCAINE

SOLUTION TO CROSSWORD No. 28 ACROSS

DOWN

1, Greenstick; 6, Aber; 10, Prism; 11, Malleolus; 12, Chandler; 13, Nasal; 15, Rasher; 16, Decadent; 19, Sesamoid; 21, In toto; 24, Ulcer; 26, Diastole; 28, Intention; 29, Reels; 30 Nose; 31, Cellulitis.

I, Gape; 2, Epiphysis; 3, Nominee; 4, Temple; 5, Calories; 7, Bolus; 8, Resolution; 9, Hernia; 14, Cross Union; 17, Emollient; 18, Windpipe; 20, Marine; 22, Natural; 23, Carnal; 25, Cites; 27, Isis.

BEN G U E & CO. LTD., Manufacturing Chelnists MOUNT

PLEASANT

ALPERTON

WEMBLEY

MIDDLESEX

FIRST AID & NURSING, JULY/AUGUST 1957

How Old is First Aid t This article tens you bow 'first aid' was carrjed out in the seventeenth century. is the term first aid? H owSomeold authoritjes say that it first appeared in 1879 and is a marriage of the conception of immediate attention-first treatmentwith National Aid Society, the name of the organisation set up after the Geneva Convention of ] 864, whose object was to help the sick and wounded. TJ-:e term first-aider, it is said, first appeared in September 1894, when the first issue of the journal First Aid appeared. Whenever the term appeared it is certain that the act-the treatment of emergency injuries by non-medical personnel-has no commencement date. Perhaps it started on the day a mother first sucked the finger of a child, to draw out the poison. Holt' old arejirst aid text books? The first St. John text book was published in 1878 and was called Handbook Describing Aids for Cases of Tf~jU/'J' or Sudden Illness and was written by Peter Sheppard) but the term first aid does not appear in it. 1t was the first published manual intended for groups of people who wanted to render service to their sick and injured comrades. A book published in J633, nearly two hundred and fifty years before the first St. John Manual, is almost certainly the earliest first aid book though the term first aid is never mentioned in it. It was written by Stephen Bradwell, a physician who dedicated its contents to the charitable reader who (imitating the Good Samaritan, hath never a hand but what is ever ready to help thy grieved neighbour.' The book is a leather bound, pocket size volume and is called Helps for Suddain Accidents Endangering Life, by which Those that live farre ./i'om Physitio71S and Chirugiol1 may happily preserve the life of a poore friend or neighbour till such time as such a man mav be had to pelfeet llze cure.

F.A. il1 Seventeenth CentUJJI England In eighteen closely worded chapters Bradwell deals with the emergencies which were likely to arise in seventeenth century England. Some of these emergencies are not unlike those with which we have to deal today. Poisons arising from things swallowed; stings and bites from venomous creatures; drowning and strangulation 'by a halter or other like means' ; suffocation from smoke; choking from things stuck in the throat; scalding from hot liquids and burns from 'fire, lime, gunpowder and the like.' All these things are familiar enough and even the cures suggested by Bradwell are sometimes familiar. , Serpents in the Body' Not so familiar to the modern first aider is dealing with serpents and worms which have crept into the body; with poisonous humours spurting or dropping from the wounds of venemous creatures; with bites of mad dogs, etc. Over eating Bradwell's cures for 'mischief from things swallowed' are often cures for the results of over eating which he dresses up for the benefit of his patients' morale. Several mixtures of pounded rue leaves and salt, figs and walnuts and other herbs are recommended for internal consumption. More radical and for 'outward use' is the following remedy: ( Take half a pen ny loaf out of the oven. Make it hollow and in the middle of the crummy side fill it with treacle and vinegar. WhDe it is hot apply it to the navel. This preserves the body and draws out the venom.' Indulging in a little advertisement he asks those who have found no relief from any of his recipes to come to his house and ask for yet another and more potent cure. Open a horse's belly . .. For those suffering from inward poisons of a long term, serious nature Bradwell recommends, with no thought to cost or availability, a cure which might well have been intended as a joke or a skit on the complicated recipes of the time. Only those of ability must attempt it, he cautions. , Open a horse, open his belly

alive and take out all his entrayles quickly, and put the poysoned partie naked into it all save his head while the body of the horse retaines his natural heate; and there let him sweat well.' During the sweating the patient was to wear on his head a little quilt made from herbs in a calico bag. His length of tenure in this unattractive place is not specified, but instructions about keeping the air round him clear with the aid of perfumes indicates a lengthy sojourn. If things get too bad he is to be permitted an occasional sniff of juniper and frankincense. Sleep is to be denied him as 'sleep draws the venom to the centre of the body,' and thirst must he bear as best he can. Should he become too demanding a quencher of new milk turned with vinegar may be given. Smoke from old shoes Instructions for dealing with serpents and worms which have crept into the body indicate the direct attack. The smoke from old shoes , received into the mouth through a funnel' is said to be highly successful in getting rid of swallowed vipers. A horse leech stuck in the throat of a man whose blood was being sucked away was to be made to loosen its hold '" h~n the juice of willow leaves be poured into the victim's mouth. For earwigs in the ear, smoke blown through a pipe into the earhole apparently did the trick. But even Bradwell is not a match for (poisonous humours spurting from the bodies of wounded venemous creatures' and all he can suggest is to get rid of the creatures before they become injured, either by driving them away' from the place of man's habitation' or by fumigating rooms with hartshorn shavings or the shavings of sheep's hooves. Pounded in a mortar . .. Cures for stings from adders and sloworms are based on the hair-ofthe-dog principle. The flesh of the animal which inflicted the harm should be pounded in a mortar and applied in the manner of a ' poultis.' Or a poultice of cock's dung and vinegar may be applied. For the bite of the shrew mouse which makes four little holes where the fang teeth enter the skin and flesh, the recommended antidote is flesh from the

FIRST AID & NURSING, JULY/AUGUST 1957

shrew mouse roasted and eaten, whilst an application to the wound itself of warm shrew mouse liver and skin is also said to be beneficial. An alternative - and here Bradwell makes no reference to any procurement difficulties-is the application to the wound of a powder made from the ground up teeth of a dead man. Even a dentist could not help unless his patient died in the chair. Offer it to the dog . .. Although he admits that not many people in England are bitten by mad dogs, Bradwell lets himself go on the subject. Should someone be bitten by a dog and not quite notice if the dog were mad, he is to dip a piece of bread in the blood from his wound and offer it to a dog which is not mad. If the dog should refuse there is cause for suspicion. Should further tests be necessary, then a walnut kernel, peeled and beaten in a mortar with blood from the wound must be given to poultry with their normal food. If they die the next day it is to be ' counted a sure thing that the biting was from a mad dog.'

Make foolish gestures . .. The effects from a mad dog bite will not show for a few days, thinks Bradwell, but after a time the victim will grow melancholy and have strange fancies in his mind. He will talk to himself and make foolish gestures. His sleep will be broken by terror and he will shun all company, taking solitary walks. (If till this time there could be no certain knowledge, now is the time to take speedy action. For once he begins to bark Ii ke a dog, to hate the light, to fight shy of all metals and looking glasses and also to fear water and all kinds of liquors, he is held to be past cure.' Wound kept open Jar 40 days! As to the cure itself, Bradwell devotes twenty-one pages to it. Details of diet and management cover many pages; ad vice to call a surgeon a few lines. And if no surgeon is available, blood must be drawn by cups and a potion made from sorrell put on to the wound, which must be kept open for forty days. Stopping the flOIV oj blood After mad dog bites, Bradwell's

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for treatment for bruises, lIlward and outward, seem a little tame but his rules for stopping the flow of blood are interesting. Use a flax dipped in white of egg beaten stiff, he counsels. Or brown paper ashes or a cobweb. For those found strangled Bradwell suggests that the maxim ' Cut a throat to save a life' may be found useful. An incision through the skin at the place where the halter was, should be made so that the 'constrained blood may be set at bberty.' As an afterthought he says this operation should only be undertaken by a skilled surgeon. Hold the patient upside down His advice on the treatment of the drowned reflects the fact that artificial respiration as it is known today was not invented until the middle of the nineteenth century and that it was the middle of the eighteenth century before serious thought was given to the idea that restarting respiration was the premier consideration in the treatment of the apparently drowned. Bradwell advised holding the patient upside down until the water had drained from the body.

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FIRST AID & NURSJNG, JULY(AUGUST 1957

Be"der~

queries Answered by Dr. A. D. Belilios J. E. C. (Tring) writes:Th ree queries have arisen during a B.R.C.S. training meeting for competitions. (1) In what position should an insensible fractured spine case be transported? OUf training manual teaches that if should be on the back 017 a rigid stretcher. If there are the minimum number of stretcher bearers, hOlv can the tongue be prevented from blocking the ainvay? We do not feel the head should be turned to one side, especially if the fracture is in the cervical region. (2) During a .first aid lecture a doctor disagreed with ' copious draughts of Ivafer' (given after an emetic) to dilute a non-corrosive poison, as he said the poison lVould be Ivashed into the intestines and therefore more readily absorbed into the system, and thus lessening the effect of a stomach pump. We would like to knolv your opinion on this matter. (3) Does the sc lerotic, lVhich covers the eyeball, lie behind the CO/~iul1ctiva, or are they part of the same membrane? The B.R.C.S. manual does not ShOH' the position of these membranes clearly. Answer

(1) Most aut.horities are now agreed that all cases of a fractured spine should be transported in the

supine posltlOn. Your question, however, raises an interesting point. Observation of the patient's breathing is essential and should difficulty in breathing occur, the mouth must be opened, the tongue gripped with the aid of a piece of clean material and pulled forwards. I see no objection to turning the head to one side except, as you say, in cervical injuries. (2) This, of course, is a matter of opinion but I favour the 'copious draught of water.' Don't forget that if the emetic fails to act, the dose should be repeated every five minutes or other methods ad oped to encourage vomiting. (3) The sclerotic is the outer coat of the eyeball itself and has not hi ng to do with the conjunctiva which lines the inner surfaces of the eyelids and also covers the sclerotic at the front of the eye. S. G . (Norwich) writes:In our factory it is my duty to examine medical certificates of workers who are absent. We have n011l had a doctor's certificate to the effect that a man is suffering from epi/eptiform fits. Would Dr. Belilios please give us some information in regard to this complaint. Answer

These are fits which resemble epilepsy but are not actually due to this complaint. Moreover the symptoms and signs are often not absolutely characteristic of true epilepsy, e.g. a patient may remain semi-conscious while he is having his fit or other variations may occur. Epileptiform fits can be due to many causes such as high blood pressure, tumours of the brain and uraemia.

FIRST AID & NURSING, JULY /AUGUST 1957

J. B. B. (Manchester) writes:J have heard of two kinds of fractures which are not described in first aid books. These are chip and flake fractures respectiv(!~) ) . J should be glad to hear more about Ihese condWol1s alld their treatment.

Answer

They are very similar conditions and as their names imply are conditions when a chip or flake of bone has been torn off the main part of a bone. The chip or flake is often minute and the injury is usually associated with a sprain. Diagnosis can only be made by X-ray and hence a first aider should have diagnosed and treated these conditions as fractures.

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First Aid &

Nursing Editor: Peter I. Craddock This journal is published on the 20th of February, April, June, August, October, December, by Dale, Reynolds & Co. Ltd., 32 Finsbury Square, London, E.C.2, for the purpose of providing an informative technical service on first aid and nursing. We welcome contributions.

Sept.jOct. 1957

In this Issue Diseases of the Heart 2 Casualties Union News 3 Pour me out an Ambulance... 4 VVounds 5 The Duke of Edinburgh's Award 6 Can Anybody Beat This? 6 Competitions ... 7 VVhat Do You Know?- No.2. 8 Crushing Injuries 9 The Circulatory System 11 First-Aider's Crossword No. 30 12 Readers' Queries 14

no you know that • •• Nutmeg is a powerful sedative and narcotic, and is the active principle in many sleeping draughts? A hen's egg, weighing 2 ozs., contains 6 grams of protein (building material) and 6 grams of fat (heat producing), the two producing energy equal to 80 calories? The average length of a new-born babe is 17 in., and the average weight 6t Ibs. ? Pott's fracture is named after Dr. Percival Pott, an English surgeon (1713-1788), who was led to study it after sustaining the fracture himself? Night-blindness is often the result of a deficiency of vitamin A? Muscarine is the alkaloid forming the poisonous principle in many toadstools?

The New B.R.C.S. Controller

MAJOR-GENERAL BRIAN DAUNT (left) gets a good luck handshake from his predecessor, MAJOR-GENERAL L. A. HA WES, when he takes over as the new Controller in the Home Department of the British Red Cross Society at the Society's headquarters in Victoria, London.

Aid & Nursing extends a F'IRST cordial welcome to General

Daunt. On September 11 th, MajorGeneral B. Daunt, C.B., C.B.E., D.S.O. (late R.A.), of VVallingford, Berkshire, was appointed Controller, Home Departme 'It, British Red Cross Society, and took up his appointment on October 1st. He comes to the Society with a magnificent r~cord, having been commissioned in the R.A. in 1920, serving in India fr0m 1921 to 1931, of which five years were spent in Mountain Artillery, during which time he was engaged in one of the frontier expeditions. He is a keen sportsman, and whilst in India was able to follow many of his sporting proclivities, walking, climbing-he has climbed in the Himalayasshooting tiger in the Central Province jungles, playing polo and sailing -he is a qualified skipper of the gunner yacht St. Barbara. In other climates he has engaged in ski-ing, another of his favourite sports. From 1931 to 1936 General Daunt served in the United Kingdom, and toured the land as an air liaison officer with the R.A.F. in 1936. In 1937 he was appointed Adjutant to a territorial regiment in Aberdeen and married the following year. 1939 saw the outbreak of the second world war, and the following year he went to France as second-in-command of his regiment and became Commanding Officer of the antitank regiment of the 9th Armoured Division in 1941, a position he held for two years, when he was transferred to the Middle East. General Daunt took over command of the

142nd Field Regiment Royal Devon Yeomanry at Salerno, became C. R.A., 1st Armoured Division until they were broken up, then C.R.A. of .the 46th Division, a post he retained until the end of the war. It was while he was with them serving in Greece that he came into close touch with the British Red Cross, acting as their agent for the distribution of food in the Peloponese. These distributions were achieved by posting a sergeant or bombardier in each village with a few men. The sergeant or bombardier soon came to be regarded as a sort of mayor of the village, and so popular did they become that when the division left General Daunt received many letters fr om the villagers asking if they could be left behind to become mayor of the village. After the war he went to India as C.R.A. of the 10th (later 7th) Division, and served in the Punjab during the difficult partition period. In 1947 he returned to the United Kingdom and commanded Coastal Brigades in Scotland and Northern Ireland until 1950, when he became Commandant of the Coast Artillery School and Inspector, Coast Artillery (Home) until 1953, when he was posted to Malta as G.O.C. During his service General Daunt has studied and practised modern training methods, and has devised ways and means of making <?rdin~ry subjects interesting. ThIS will, doubtless prove most valuable to both the' Society and to him in his new post.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

A Course in Elementary Medicine

affecting the heart A NYhasailment always been much feared by the layman. Hence it is fitting to begin this article by pointing out, in no uncertain terms, that in many cases these fears have been gravely exaggerated in the past and are still, even in the present. Many heart ailments do not require medical treatment at all ; others can be effectively treated by medical methods particularly nowadays, while a very large number of supposed heart ailments are not in fact due to disease at all but can be traced to nervous and other causes. The nervous factor cannot be too strongly emphasised. Many people who think they have something wrong with their hearts have no disease whatever. Thus a young man, greatly distressed, called on his doctor and described how his heart would apparently miss a beat at frequent intervals and then become irregular for a short period. A brief examination disclosed that this was due to extra beats or systoles as they are called technically. Questioning revealed that he had recently proposed to his girl friend but she had replied that she would like time to think it over. When she had decided in his favour, his irregularity almost instantly disappeared! Cases such as this could be multiplied enormously but it is always essential to preserve a balanced outlook and when there is any fear of a heart ailment to obtain professional advice as soon as possible since fear tends to ' build up , and of course there are large numbers of true heart ailments for which treatment is required. So far as possible in these articles, it is the custom to describe the anatomy and physiology of the organs concerned before giving a description of the diseases to which they are liable. This, in the case of the heart, however, would be too lengthy hence the reader would be well advised to revise his knowledge of the circulatory system by reference to a text book on elementary

Diseases of the Hea,·t By A. David Belilios M.H., B.S. (Lond.), D.P.H. (Eng.)

anatomy and physiology or to the appropriate sections of his first aid or nursing manuals. Auricular fibrillation Extra systoles as a cause of irregular action of the heart have already been mentioned hence it is suitable at this stage to describe auricular fibrillation which is another example of irregularity but this time due to disease. In a normal heart, the auricles beat or contract first and this action is followed almost immediately by the beating of the ventricles. A pause follows during which the heart rests and then the cycle is resumed. As is well known, the heart beat takes place 60-80 times a minute. In auricular fibrillation, the auricles tend to beat rapidly and irregularly-perhaps 400 times a minute. Many of these bea ts are not strong enough to produce contraction of the ventricles which, nevertheless, follow the example of the auricles by beating more quickly than normal and also irregularly both in rate and strength. It follows that the pulse is also irregular. Auricular fibrillation results when the muscle of the heart has been damaged through an illness such as rheumatic fever or hardening of the arteries (arteriosclerosis). It is normally accompanied by some of the symptoms and signs of congestive heart failure which will be described later. Fortunately medical science possesses a well tried remedy for this condition, a drug called Digitalis, obtained from the purple foxglove. This slows the beat of the ventricles often to normal and improves the general circulation. Thus a sufferer from auricular fibrillation can live a useful and happy life although he may have his physical activibes somewhat restricted. Tachycardia This term is used in medical language to describe rapidity of the

heart beat which, however, remains normal in rhythm and regUlarity. The normal rate of the heart beat and, of course, the pulse ill adults is anything between 60-80 times a minute. In tachycardia the rate may be increased up to as much as 160 or more beats a minute. Tachycardia can be due to many causes besides an actual disease of the heart. It occurs , for example, after haemorrhage and in shock; it may be a sign in diseases such as tuberculosis or goitre or, once again, it may be purely nervous in origin. Bradycardia This is the reverse condition in which the heart beats more slowly than normal- less than 60 times a minute. It may occur in apoplexy, compression of the brain as well as in other conditions such as growths and meningitis. An important heart disease in which bradycardia occurs is known as heart block which results from damage caused through disease to the muscle of the organ. Some people, though perfectly healthy , have pulses which are considerably slower than the normal. Napoleon, for example, is reputed to have had a pulse rate of 50. Pericarditis This is inflammation of the pericardium, the outer coat of the heart which consists of two thin layers. These secrete a watery fluid which acts as a lubricant and prevents friction when the heart beats. Pericarditis generally occurs as a complication of another ailment such as rheumatic fever, chorea (St. Vitus's dance), scarlet fever, etc. In its acute form it may occur in two varieties, dry pericarditis and pericarditis with effusion. In dry pericarditis, the two layers of the pericardium become red, swollen and inflamed; a thick sticky exudate like butter spread on bread may form on the two layers. The patient complains of severe pain in his chest over his heart. There is usually shortness of breath

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

and a cough. A raised temperature and increased pulse rate accompany together with symptoms such as lassitude, loss of appetite and a general feeling of ill health. In pericarditis with effusion, fluid (or effusion) collects between the two layers of the pericardium. Pain may disappear but the action of the heart is disturbed and this shows itself by shortness of breath and cyanosis in addition to the symptoms above described. Both these varieties of pericarditis clear up comparatively quickly, but there is always a risk that a chronic form may persist in which the two layers become partially stuck together. In this event, the heart has persistently to work against an increased resistance and therefore becomes enlarged or hypertrophied as it is called. This in itself does not matter so long as the strength of the heart muscle is maintained. The word hypertrophy must be furt.her explained. It is well-known that if any part of the body works harder than the purpose for which it was intended, it becomes bigger alld stronger. Blacksmiths, for example, develop stronger and thicker muscles in their right arms than in their left. Similarly if the heart as a whole or any pa rt of it has to work harder than its normal it hypertrophies. This is a safety measure since it enables the heart to maintain its efficiency. Chronic pericarditis often causes the heart to hypertrophy to a marked extent-indeed some of the largest hearts on record can be traced to this cause. Chronic cardiac failure This is a common ailment and results when the heart is no longer strong enough to maintain an efficient circulation. It often occurs when one or more of the chambers of the heart have hypertrophied to their maximum and the muscular coat of the organ (myocardium) can no 10nger keep up its work. Chronic cardiac failure has rna ny causes such as certain disease of the valves, prolonged high blood pressure, etc. It is uncommon before middle or old age. The disease develops gradually. Often the first sign noticed by the patient is some shortness of breath occurring when he exerts himself unduly; this shortness of breath

increases as time goes by until it occurs even on slight exertion. Oedema or drop sy is an important sign. This means that fluid accumulates in the tissues under the skin causing swelling which can easily be distinguished from fat since a dent is 1eft in the skin after pressure by the exami ner with his fingers or thumb. The oedema is first noticed in the ankles and feet towards the end of a day but gradually increases both in its amount and extent. Other symptoms and signs may affect almost every system of the body. Thus auricular fibrillation is often present, there is loss of appetite and indigestion, blueness (cyanosis) of the lips, cheeks, ears, etc. The patient ~asses less urine than his normal and its colour changes, becoming darker. An irritable cough is often present and blood stained sputum may be coughed up. Sleeplessness and nervous irritability may accompany.

The comp1aint is easy for a doctor to diagnose and there is much that can be done for the pa tient. Rest in bed with the head and shoulders raised is essential. The amount of fluid that the patient drinks is often reduced and he is given a light and easily digested diet in which common salt is restricted sometimes to a marked extent. The well-known digitalis is very valuable while other drugs usually given by injection increase the output of urine and thus remove the fluid which has accumulated in the body. Oxygen may be necessary in serious cases to relieve difficulty in breathing but there are also other remedies for this unpleasant symptom. Many cases respond satisfactorily to treatment but they must be prepared for some restriction in thei r future activities and very often having to continue with some of the d rugs they have been given.

Casoalties Union News CASUALTIES UNION DAY THE programme this year introduces some new events . but retains most of those which interes t~(1 us last year. One special event is the study in civil rescue, removing an unconscious man (concussion) from a sewer manhole . Twenty teams have been studying this problem, and will submit their method in writing before the day, on the day itself they will demonstrate the method they have described. The competition is to be held at London University Sports Ground at Motspur Park. ANNUAL CONFERENCE The Conference is to be held again at the H .Q. of the Metropolitan Regional Hospital Board, 11 Portland Place, W. 1. The programme is a varied and interesting one, and has been designed with the common aims of providing items of special interest for the members and to further the development of the Union . Full details will be given in the next column of copy of Casualties Union N ews. BRIGHTON Brighton Branch made good use of their lovely beach and staged a realistic drowning accident, with two trained 'casualties' in the sea, as a caution to careless bathers and also as practice to the local ambulance men. Crowds of excited spectators watched the dramatic rescue operations. The local St. J.A.B. also arranged for two rather 'bloody' casualties to be treated near the Palace Pier, much to the discomfort of various passers-by, who were horrified witnesses of a nasty ' accident. ' HAMPSlllRE A splendid record of service has been given by this Branch, during the last 18

months they have provided casualties for 244 incidents for 13 different first ai d organisations , including tra in and plane crashes, two isolated cases which invol ved ] 40 casualties. A new venture was the supplying of casualties for the benefit of junior seamen of H .M .S. St. Vincent at Gosport, who a re being trained in fi rst aid fo r the Duke of Edinburgh's Awa rd . READING BR~CH They not only take part in ma ke-believe rescues, but one of their mem bers named Peter Brooks did a real life job recently when he saved the life of a man who was drowning in the River Kennet. Peter's main hobby is first aid, and he is a keen member of C.U. Our congratulations to Peter for being prepared for when the rea l thing turned up . SCOTTISH BRANCHES Casualties Union members in Scotland held a training weekend and Conference recently, which was arranged by Lyndoch Branch and held at Kinnaird House, Erskine Hospital (by kind permission of Col. Arthur, Scottish Secreta ry, B.R.C.S.) This weekend proved to be of great value to all our members ' no rt h of the border ' who can not make the long journey to London . This we hope will be the first of many such a nnual get-togethers. ALTRINCHAM BRANCH This Branch provided casualties for a very interesting period of training for a Red Cross detachment, who were preparing for the Stanley Shield Competi~ion. 40 casualties were provided for 18 seSSIOns, and they ranged from a simple nose bleed to fractures and home nursing cases.

FIRST AID & NURSING, SEPTEMBERjOcrOBER 1957

Pour ,ne out a" A",bulance!

WHAT is it that bounces, admits light, won't rust or fade, and can be repaired with an infra-red lamp? The answer can be found at the London County Council's vehicle repair shop at Wandsworth. Here, ambulance bodies are being built from reinforced plastics- literally poured out. Vehicles under repair include some of the Council's fleet of ambulances. It is inevitable that ambulances hastening through thick traffic t~ answer an emergency, get an occasional dent. That is where the idea of plastic panels came in. By using them for replacements of rea~ corner panels on the large DaImler ambulances, repair costs and the time spent by the vehicle in the repair depot were drastically cut. The plastic panels, owing to their natural resilience, proved to be highly resistant to minor accidental damage. So successful were the early experiments that it was decided to build complete bodies of glass-reinforced polyester resin, which could be moulded on the premises for the Council's new Austin am'bulances. Dexion plays a part at several vital stages in this new approach. A mock-up in wood was used as a pattern for making the various moulds. Three separate moulds were required for the roof and side panels. The moulds themselves were m~de of glass-reinforced polyester resm, and have a glass-smooth surface. The making of a body section starts when the first coat of resin is sprayed on the mould. This is known as the' gel' coat. Next a !llat of chopped glass strands is laid m the mould and a further coat of polyester resin (pigmented to the desired colour) is stippled in. A battery of infra-red lamps' cure' the : l~y-up , and after about four hours It IS removed from the mould and allowed to ' season' for a fortnight. The body is finally assembled as a complete unit, wired up for lighting

and mounted on the chassis. Even the interior lockers are fitted in the body before final assembly. For ambulance use, special modifications have to be made to the springs and shock-absorbers. The chassis are altered in the workshops and a Dexion jig is used to position the outriggers for the body mountings prior to welding. As the ~olour is introduced during the mouldmg, no painting is required and, a~ there is no metal in the body, corrOSIOn problems do not arise. Should the plastic bodywork be damaged, repairs are easily effected by the insertion of a patch and a few hours heating with an infra-red lamp. Plastic panels do not suffer Interior of glass fibre ambulance body

from dents of the kind which, on a metal body, would require panelbeating to straighten. . Where ambulances are concerned an important feature, is the fact that the roof can be made translucent thus obviating the need for roof windows; sufficient light comes through the plastic roof to give a soft, diffused effect within the vehicle. The necessary patterns and moulds are, of c~)Urse, somewhat costly in the firs~ mstance but the saving in productIOn costs compared with conventional materials soon pays for initial outlay. Twelve plastic-bodied ambulances are being built this year and the production of larger numbers as ~eplacements for existing ambulances IS contemplated. The use of reinforced plastics for vehicle building is still in its infancy and the L.C.C. enterprise will undoubtedly be closely watched by sections of the motor industry.

Extract from the magazine' Dexion Angle.'

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

Wounds By W. James Wright, S.R.N., B.T.A.

A WOUND is a break in the

continuity of the skin or mucous membrane and other soft tissues of the body, thus allowing disease producing germs to enter and also allowing the escape of blood. Varieties of wounds (1) Lacerated wounds~ are caused by such things as machinery or the claws of an animal, and are recognised by the torn and rugged edges of the wound. Bleeding may not be severe and may be delayed, as the blood vessels are torn and not' clean cut.' (2) Incised wounds are caused by sharp cutting instruments such as a razor. The edges of the wound gape and bleeding is free as the blood vessels are' clean cut.' (3) Contused wounds. Crushing, or a direct blow by a blunt instrument is the cause of a contused wound. The surrounding tissues are usually bruised. (4) Punctured wounds are caused by sharp pointed objects such as a needle or a bayonet. The opening of the wound is usually small but the wound may be deep. Blood vessels, nerves, or internal organs may be damaged. (5) Abrasions. These are superficial lacerations due to some mild form of injury such as falling on a rough surface. Gunshot wounds corne under one or more of the first four varieties. For purposes of classification wounds can be placed into three groups. (a) Aseptic wounds. These are wounds such as are made during a surgical operation, where everything is sterile. (b) Potentially infected wounds are caused by contamination from some unsterile object. They are wounds which unless treated correctly will become septic. Most wounds obtained accidentally come into this group. (c) Infected wounds. If harmful germs get into a wound and they are not destroyed, sepsis occurs, and the wound becomes infected. A potentially infected wound not correctly treated can easily develop into an infected wound.

First aid treatment of wounds (1) Immediately expose the wound so as to get a better estimate of the amount of damage. Do not remove m?re clothing than is necessary as thIS would only help to increase shock. (2) If there is severe bleeding lay t~e patient down as blood escapes wI.th less. ~orce when the patient is in thIS pOSItIOn. Any severe bleeding should be arrested immediately. In the case of a limb, this should be elevated, if the limb is not fractured. (3) Do not disturb any blood clots as this is nature's way of controUing bleeding. (4) F'Oreign bodies that are \·isible should be removed, if possible, but do not probe for foreign bodies as you may push them deeper into the wound. (5) Clean the wound with some antiseptic solution, taking care to wash [rom the wound outwards so as to avoid washing dirt into the wound. (6) Apply a clean dressing, sterile if possible. (7) Bandage firmly but not tightly enough to stop the circulation. (8) Treat for shock if necessary. (9) Obtain medical aid in severe cases of wounds 01 haemorrhage or if in any doubt. Surgical treatment of potentially infected wounds Space does not allow a description of the surgical treatment of the three classes of wounds, but here, briefly, is _the surgical treatment given for potentially infected wounds. Potentially infected wounds should be thoroughly examined. The edges of the skin are excised and the wound itself, is enlarged sufficiently, if possible, to see the entire depth. Any tissue that causes tension on the wound should be divided. All foreign bodies are removed together with any dead or damaged tissue as these may cause sepsis. If contamination is not severe and penicillin treatment is given, the wound may be closed by suturing (stitching). Sulphonamide powder may be dusted into the wound before it is closed, as an extra precaution. A vaseline dressing is usually placed over the wound after it is closed. This is covered with a plain gauze dressing and a pad of cotton wool. The whole dressing is then secured firmly by bandage or

adhesive tape.

If there is gross

~ontamination of the wound, sutur1l1g may ~e delayed for a few days in

case sepSIS occurs. How a wound heals A wound can heal in one of two ways, and the type of wound plays a big part in the way it heals.

(1) First intention or primary union. Briefly this is what takes place. The plasma or fluid part of the blood, oozes into the wound and solidifies, glueing the edges together. - Then a substance known as fibrin cO.mes oyt of t~e s?1idified plasma: rruxes WIth speCIal tIssue cells and in due course forms immature fibrous tissue. Adjacent capillaries send out branches to form a fresh blood supply to the affected area. After a while the immature fibrous tissue becomes organized and cells growing from the edges of the skin and mucous membrane complete the surface closure or scar. There are certain factors which help a wound to heal by first intention. The wound with cleanly cut edges is the most likely to heal this way, especially if it is an aseptic wound . All bleeding must be controlled thoroughly and if necessary the wound edges must be brought together by accurate suturing. If it is suspected that blood or other fluid may collect, drainage tubes should be inserted to allow the fluid to escape. (2) Second intention. Healing by second intention takes place in wounds which have been allowed to gape, or where there is loss of tissue. Granulation tissue develops from the sides and bottom of the wound and gradually fills the wound cavity. Quite often there is a copious discharge of pUS or serum from wounds healing by second intention. Healing must take place from the bottom of the wound and therefore superficial granulations must be checked by cauterising them with pure carbolic or 'silver nitrate stick. After a while the wound cavity becomes filled with the granulation tissue which eventually becomes converted into another special tissue, known as fibrocicatricial. Epidermal cells grow in slowly from wound edges and scar is completed.

FIRST AID & NURSING, SEPTEMBER /OCTOBER 1957

Ca., Anubodu Beat TI,;s? DAY after day we are horrified by the stories we read in our national and provincial press of the crimes committed by teenagers who are roaming the streets and commons aimlessly, seeking-we are toldvictims. Our courts and prisons are becoming congested with these boys-and girls, too, sometimes-whose operations have attracted the representatives of the law, and whose activities it has been found necessary to curb. Are these youngsters really bad? Are they really criminals, or are they merely victims of their own misguided energies? Whilst the psychologists are endeavouring to find the answers to these quest.ions, His Royal Highness, the Duke of Edmburgh, a practical man if ever there was one, has decided to do something. He sees these young men as the citizens of the future, and the pillars of our Empire, and visualises them as a credit to themselves and to society if only their youthful energies and abilities could be steered in the right direction. With this object in view he has devised a scheme wh ich has now come to be known as th~ 'Duke of Edinburgh's Award,' to encourage these lads to utilise their abilities in a manner which will bring credit to themselves and at the same time help them to ~elp. in making the world a better place to ltve 10. The scheme is designed to offer t~em opportunities and encouragement to hve fully, and to make the best use of their leisure, by engaging in activities which are both .enjoya.ble and cha.racter-building. It IS ObVIOUS that HIS Royal Highness has made an intensive study of our youth, f~r he sees the boy as possessing four dJfferent angles of approach and it is with a full recognition of the fou.: aspects of the boy's character that he proposes to endeav~:)Ur to attract him. Much tact will be required, and care must be exercised in the selection of helpers, but it can be done, and there IS, undoubtedly, a great future for the scheme. He summarises h is objects in a letter ,:"hich appears on the fly-leaf of his bO,?klet. Jssued to those who are offering to aSS1st him: Buckingham Palace. YOllng people growing up in industrial communities have many difficulties to lace. Parents, clubs, voluntary organisations equalfy have to overcome many problems. ThiS scheme is designed to help both the you~g and tl!e grown up. It is designed as an introductIOn to leisure time activities a cha~/enge to the individual to perso~al achievement, and as a guide to those people and organisations who are concerned about the development 0/0111' future citizens. 1 hope that all those who take part in this scheme will find an added purpose and pleC!sure. in their lives, and that sense 0/ salis/actl.on which comes from successfully overcomll1ff. a challenge or helping others to Ol'ercome It. (Sd.) Philip.

Bearing in mind the four aspects of the average boy's character, he has suggested four outlets for his energies, and has

offered awards for the attainment of success (not competitive, as he emphasises) and the achievement of a goal. He has divided the scheme into four 'sections' in each of which he chalJenges youth to succeed, viz. (a) Rescue and Public Service Training (b) Expedition (c) Pursuits and (d) Fitness. Perhaps we could not do better than quote from his own brochure the respective aims of the four sections: (a) To influence young people to realise that as members of a community they have an obligation to others. For this purpose a candidate will be required to prepare himself so that he can render to his fellow men some form of service for which he has trained. (b) The aim of the Expedition section is to provide an incentive for the spirit of adventure latent in young people and, by so doing, to develop their character and powers of leadership. (c) The object of this section is to act as an incentive and an encouragement to discovering and developing the natural interests and aptitudes of the individual, by tasks demanding initiative and perseverence such as research, study, art or craftsmanship. It should, therefore, leave plenty of scope for local adaptation and variety. (d) The Object of the Fitness section is to provide an inducement to attain physical fitness, and a positivf means of measuring physical effort independent of personal opinion. As section (a) is the one in which we feel that we may be of s~me assistance, a few words of comment WIll not be out of place. Of the many forms of rescue and public service training, he has listed as examples first aid, life saving training, accident preventIOn and road safety training and home nursing. as well as many others. Appeals have been made to the various youth and other voluntary organisations to cooperate, and it is gratifying to note that the British Red Cross Society, the St. John Ambulance Brigade, the St. Andrews Ambulance Association, the Royal Life Saving Society, the Royal Society for the Prevention of Accidents and the Royal College of Nursing are amongst the many whIch have expressed their enthusiasm for the scheme. It need hardly be added that First Aid & Nursing readily offers its services, and will be willing at all times to do all possible to advance this splendid effort. We appeal to all those who have the ~nterests of the young at heart, and especIally those who possess specialised knowled~e, and. the ability to impart it, to offer theIr serVIces. The Duke of Edinburgh has been fortunate in securing the services as Secretary of the scheme of Brigadier Sir John Hunt, CB.E., D.S.O., D.CL., LL.D., whose name alone is an inspiration, and who would be pleased to furnish fuUer particulars if written to. Any enquirie~ should be addressed to the Secretary The Duke of Edinburgh's Award, 32 Brya~ston Street, London, W.l. F.CR.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

Co." petitio.,.s

Firsl Aid & Nursing has received the following letter from a Blackpool reader, who signs himself' F .W.' I have been a member for over 58 years of the SJ.A.A. and the S.J.A.B. I received my first certificate in 1899 and nursing in ] 901 and have not missed one year efficiency since that date. However, through leaving the district, I have resigned, but am still interested, of course, in the movement. I have been a regular reader of your journal since 1903, or thereabouts. I am still a reader and have greatly improved my knowledge as a consequence. I often wonder if tltere are any members who have served the movement for so many years and been a reader of your journal so long? Yours sincerely, 'F.W.'

NEW INDUSTRIAL MEDICAL CENTRE AT AYLESFORD A

NEW medical centre on the Reed Paper Group's large industrial site at Aylesford, near Maidstone, Kent, has recently been completed. Designed in the Group's architects' department, the building was required to fulfil the threefold role of administrative headquarters for the medical department, main surgery and a cent~e for ancillary services, such as dentistry and chiropody. The centre serves more than six thousand men and women employed in all aspects of the manufacture and conversion of paper and packaging materials. The building is set back from a main company road in a central position amongst the various mills and factories, and standing space has been provided for ambulances and a small park for private cars. As th~ site is on valuable mill ground, it was deCided that the building should be designed on two floors. The ground floor accommodates the main surgery with necessary waiting rooms for men and women, recovery rooms and a general office. On this floor also there is a main entrance hall from which the staircase leads to the first floor. On the first floor is the medical officer's consulting and waiting rooms, dental ~urgery, c,hiropodist's room, medical superJn~endent s offices, locker accommodation, tOIlets and a small kitchen for nurses. A large room on the same floor is available for various purposes, including St. John's ambulance lectures and collection of blood by the National Blood Transfusion Services. The building is constructed in loadbearing brick cavity walls with a solid concrete ground floor and precast concrete beam first floor.

National Hospital Service Reserve (Mobile Units) Finals AFTER being held in London for four consecutive years it was a fitting gesture for the Ministry of Health to arrange that this year the National Hospital Service Reserve (Mobile Units) final competitions should be held in the Sophia Gardens Pavilion, Cardiff, first of all because the present holders of the Minister . of Health's Challenge Cup are the members of the team rep"resenting St. Tydfil's Hospital, Merthyr Tydfil, and, secondly, in recognition of the magnificent contribution which Wales has made to the N.H.S.R. itself. Nearly 200 teams had taken part in the eliminating and regional rounds, the L4 surviving teams coming to Cardiff. In the morning the 14 regional winners contested the semi-final round, and the four resulting winners competed in the final in the afternoon. Those spectators who had anticipated witnessing the orthodox ambulance or nursing competitions were to receive a big surprise, for what they did see was something far more elaborate and complicated. In order to appreciate fully the significance of the competitions, it is necessary to understand ~':::. 1 unctions of these mobile units. ~:Jey are designed to deal with m;:- ~,) 'bomb incidents in case of total war, and their organisation and training is directed to that purpose. In the competition each team in turn is deemed to have been called from its hospital through the Hospital Group Officer and instructed to report to a specified Post Controller. They then have to set up a first aid post in a building or part of a building indicated for the purpose. This is represented by an enclosure within the arena. Each team consists of a doctor, a trained male or female nurse (who may be a trained nursemember of the N.H.S.R.) and eight auxiIiaries of the Reserve, who are either St. John, St. Andrews or B.R.C.S. members. The team arrives in two cars and their equipment is carried in a 30 cwt. station van. The medical officer in charge of the tearn reports to the Post Controller, who gives him a brief account of the situation and shows him the building (perhaps onJy partly damaged, but offering suitable accommodation fOl' the purpose) which has been allotted to the unit. The M.O. makes a quick survey and instructs the team how the unit is to be deployed, bearing in mind that he may have to deal with a large nwnber of casualties. The team then proceeds to unload and set up its equipment as speedily as possible to be ready to deal with casualties. Casualties bcgin to arrive, some walking, some on stretchers and some carried or assisted by wardens. The doctor and the trained nurse, assisted by the N.H.S.R.

(Left) The winning team, Rochdale and District H.M.C. with Minister of Health's Challenge Cup. Present also are judges Major-General W. R. Dimond and Dame Elizabeth Cockayne. (Right) The action of one team on a group of 48 casualties which each one had to treat in h:Jlf an hour!

auxiliaries, examine and treat casualties, and the doctor decides which cases should be sent to hospital by ambulance, making certain in each case that the patient is in a fit state to stand what may be a rough journey over damaged and debris-littered roads. Particulars of aU casualties are recorded by a member of the unit. The Post Controller details stretcher-bearers to remain with the unit fo assist in moving the stretcher cases inside the building. Units will be expected to evacuate by ambulance or sitting case car only those casualties deemed to be in need of further immediate treatment in hospital. Ambulance cases are loaded with the help of stretcher bearers into ambulances, which drive off. Walking cases deemed to be fit to return to their own homes or to a rest centre after treatment are despatched on foot under the care 0' an escort provided, on request, by the POSt Controller. Once again the Casualties Union were called upon to playa most important part by providing the 'material' upon which the competitors would work, and this year the task was heavier than ever. For the purpose a whole army of specialists, consisting chiefly of 'fakers', or make-up artists and 'patients' descended upon Cardiff from all parts of the United Kingdom, bringing with them cases of make-up materials with which to carry out their task. This huge army was under the direction of their energetic hon. secretary, Mr. P. G. Sargeant, who is himself an expert. Over 50 different types of injury had to be prepared, so that it would obviously be impossible to detail them all here, but the following, selected at random, will serve to illustrate the difficulties which faced the competitors and the knowledge and skill of the 'fakers' and 'patients': Rupture of blood vessel in lumbar spine (simulating the symptoms of a bro~en lumbar spine); compound fracture of nght femur with arterial bleeding; chest injury with fractured ribs from a crush; concussion (patient had been in a nuclear airraid 12 miles away and had been found

lying face down in the mud); internal haemorrhage (patient had been in a nuclear air-raid 12 miles away and haa been discovered trapped amongst fallen debris); crushed foot (patient had been found pinned under a heavy piece of timber following a nuclear air-raid); flash burn (patient's right leg had been exposed to heat flash); complicated fracture of ribs ; shock-attempted suicide- slashed right wrist; mixed burn of hands and forearm ; spicule of glass in upper eyelid (patient was near the window when the house was demolished in a nuclear air-raid and was discovered in a mass of shattered glass and broken masonry); flesh wound of hand (patient has torn fleshy part of right thumb on barbed wire). Each team had to deal with 48 casualties, including 10 serious stretcher cases, all within the space of half-an-hour, and marks were awarded for: (a) Turn-out of personnel, discipline on arrival, evidence of clear apportionment of duties; (b) Method of unloading, unpacking and laying-out of equipment; (c) General organisation of unit with regard to facilities for treatment, etc. (d) Reception, documentation, treatment and disposal of casualties. The equipment carried by each unit consisted of everything which would be required to establish a temporary casualty department-beds, tables, sterilisers, instruments, drugs, dressings, bandages, stretchers, etc. The competitions were judged by Major-General W. R. Dimond, CLE., CB.E., I.S.M. (Retd.), a Medical Officer of the Ministry of Health; Dame Elizabeth Cockayne, D.B.E., S.R.N., S.CN., Chief Nursing Officer of the Ministry of Health and Colonel E. H. P. Lasseu, D.S.O., R.A.M.C The final results were: I. Rochdale Hospital, Rochdale Hospital Management Committee (Manchester Regional Hospital Board). 2. St. Tydfil's Hospital, Merthyr and Aberdare Hospital Management Committee (last year's winners).

Forthcoming Events Wednesday, October 23rd Wednesday, November 6th Thursday, November 14th Saturday, December 14th

General Post Office National First Aid Competitions, Porchester Halls. Dock and Harbour Authorities Finals, Weston-super-Mare. Grand Prior's Trophy, Porchester Halls. Ealing Open Competitions, Ealing County Grammar School.

8 City Hospital, Nottingham No. 2 Hospital Management Committee (Sheffield Regional Hospital Board). 4. Friarage Hospital, Darlington and Northallerton Operational Group (Newcastle Regional Hospital Board). The members of the winning (Rochdale) team were Dr. G. P. Walker, M.B., Ch.B., D.R.e.O.G. (in charge), Mr. E. O'Callaghan, S.R.N., Nurse Tutor, Auxiliaries Mrs. D. Drewry, Miss e. M. Howarth, Miss I. Lloyd, J. Mills, Mrs. L. Russell, Mrs. M. Smith, Mrs. E. Speak, Mrs. S. E. D. Tomlinson. Reserves: Mrs. A. Brodrick, Mrs. E. Matthews and Mrs. K. Simpson. The remaining teams which competed in the morning (not placed in any particular order) were: Windsor Group, Windsor H.M.C. (North-west Metropolitan R.H.B.); Brook General Hospital, Woolwich H.M.e. (South-east Metropolitan R. H.B.); Kettering General Hospital, Kettering H.M.C. (Oxford R.H.B.); Coventry and Warwickshire Hospital 'A' (Birmingham R.H.B.); Bradford Royal Infirmary, Bradford 'A', H.M.C. (Leeds R.H.B.); Ipswich 'Red,' Ipswich and East Suffolk H.M.C. (East Anglian R.H.B.); Thurrock Hospital, Tilbury and S.E. Essex H.M.C. (North-east Metropolitan R.H.B.); Bolingbroke Hospital, Battersea and Putney H.M.C. (Southwest Metropolitan R.H.B.); Southmead General Hospital, Southmead H.M.C. (South-west R.H.B.); Whiston Hospital, St. Helens Operational Group (Liverpool R.H.B.). The Minister of Health's Challenge Cup was presented to the winning team by Mr. J. K. Vaughan-Morgan, M.P., Parliamentary Secretary to the Ministry of Health, deputi~ing for Mr. Dennis Vosper, who was absent through illness. On the platform he was supported by MajorGeneral J. M. Kirkman, e.B., C.B.E., Commissioner-in-Chief of the St. John Ambulance Brigade, the Lord Mayor and Lady Mayoress of Cardiff and the judges. Whenever large numbers of people are gathered together it is always a safe precaution to be prepared for any REAL accidents which may occur, and in anticipation of these a first aid post had been established, which was in charge of a doctor, assisted by nurses from the British Red Cross Society and the St. John Ambulance Brigade, all of whom were members of the N.H.S.R. Information concerning the N.H.S.R. and its activities was to be obtained from the Information Centre, presided over by Mr. S. A. Heald, O.B.E., Public Relations and Principal Press Officer, Ministry of Health, who was also assisted by personnel from the reserve. Mr. Heald states that he and his staff were kept busy as a result of the great interest shown by members of the public. Recruits are still needed, and we would add our appeal to members of the public who are interested in their fellow creatures to make enquiries from the matron of your nearest hospital. She will be delighted to meet you and to furnish you with full information. It is a worthwhile occupation.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

Fire Brigades National Finals WHO said that firemen can only extinguish fires? That they are also expert first aiders was proved conclusively at the Cambridge Hall, Municipal Buildings, Southport, on the occasion of the National First Aid Competition for Local Authority Fire Brigades, when the winning team scored 90 % of the possible marks. The competition was for the St. John the Baptiste Trophy, and was held under the auspices of the St. John Ambulance Association. After the teams had drawn for position, the Mayor of Southport, Councillor Mrs. Mae Bamber, J.P., extended a cordial welcome to the teams, their supporters and the audience, and as soon as she had announced the commencement of the competition, the first team was ushered in. Team Test, judged by Dr. D. Osborne Hughes, of Birkenhead: The scene is a fire. The ' team has been detailed by a senior officer to attend one of their colleagues who has fallen from a burning staircase. Injuries: Burns of hand and right forearm, fracture of right patella, wound of left thigh. Dual Practical Tests, judged by Dr. Charles Sharp, of Liverpool: Nos. 1 and 3 are as\.rJ 0 ".'vc atlcntion to a man who has been l. un g b-y a l,._ <ill-iag him to fall and injU[ '1is right elbo w. Injuries: Fracture 'J' right IpPlr limb at elbow, bee sting on r ' ... ht t'o"- .II tn , s-hc;:' Nos. 2 and 4 see ,_ .'1:<1 IT Iroo.t of t 'em stumble and fall off the kerb. Injuries: Simple fractures of 7th and 8th left ribs, strained calf muscle, shock. At the presentation ceremony the chair was occupied by J. A. Perkins, Esq., Chief Fire Officer, Southport, who was supported by the Mayor of Southport; Horace F. P~rshall, Esq., T.D., M.A., (Oxon.), DIrector-General of the St. John Ambulance Association, and the judges. The results were then announced,

together with the marks obtained out of a total of 400:

1. City of Manchester, District No.1... ... ... ... (winning the St. John the Ba ptiste Trophy) 2. County Borough of Great Yarmouth, District N o . 5 . . . 3. City and County of Kingstonupon-Hull, District No.3... 4. City of Cardiff, District No.8... 5. County of Surrey, District No.6 6. County Borough of Middlesbrough, District N o . 2 . . . 7. County of Dorset, District No.7 8. County Boroughs of Smethwick and West Bromwich, District No.4...

by F. C. Reeve, F.Z.S., F.R.E.S., F.I.C.A.P. 354

350! 315 310 306 296t 278t 267

Responding to the invitation of the Chairman, Mr. Parshall presented the trophies, and congratulated the teams upon their work. A vote of thanks to all those who had c.ontributed to the success of the competitIOn was proposed by S. H. Charters, Esq., H.M. Inspector of Fire Services, brought to a conclusion a most enjoyable and instructive event. The arrangements were once again in the cc ITIp~l.enf lldr ds of Mr. George Craft, the well-kno~vJ1 r mpetition Secretary of the St. John Aml. dance Association. it is interc.' 109 0 not:e the t this is the S yt;.lth al LU I competitron ror members of )r I.ltr. JI' fire br igades fer (he cha.mplvli"rup tr oy an! plaques pre..,~. 're t by the St. John Am bl'lan e j "SL cj"lf. Each year has seen an increase .0 the number of teams ente[ln~, and tbe FIre Service Research and Tramm T··u~t have presented perpetual shields in each distrtct of the Chief Fire Officers' Association. City of Manchester, the winning team, will represent the fire services in the Grand Prior's trophy competition to be held at Porchester Halls, Bayswater, on November 14th.

IYAdPoYou/(ItOtU?

No.2

on FIRST AID

1. How many bones are there in the wrist? 2. How are joints formed? 3. Describe a ball and socket joint. 4. The muscles of the body are classified into groups. How many groups are there and what are they? 5. What are the main organs contained in the chest cavity? 6. The skin is formed in two layers. What are they? 7. What divides the trunk into two large cavities? 8. What is a dressing?

Answers on page 12

Crushing Injuries Crush Syndrome DESPITE the fact that I am 70 cases were passed under review, frequently hearing judges reonly one-third of this number remark, ' I can't find anything fresh to covered, and it was admitted that set them,' yet, upon glancing through they were, for the most part, minor my file of marking sheets for the ones. past few years, I am able to find very few tests in which 'crushing inTwo Governing Factors juries' have been included. Although Two factors appear to govern the the instructions given in the official prospect of recovery, viz: (a) the text-books to administer alkalies superficial area of muscle which bas have occasionally evoked a question been compressed and (b) the length or two, it does not appear to be of time during which it has been generally realised that this class of under pressure. It was found, also, injury presents not only some unthat for some unexplained reason, it usual features, but is often followed was a far more serious matter for the by an interesting condition characleg to be crushed than the arm. The terised by what has come to be investigation sh0wed, also, that the caned the 'crush syndrome,' of typical 'crush syndrome,' which wbich very little has been written for includes renal complications, did not the first-alder. follow if the limb had been comIt may be argued that, as this pre~r ('- d for only one hour or less, interesting condition does not drbut I it had been under pressure for velop until at lea<;t 31 ~ ',ll (lll:. tne _ anyt lg from 1 to 4 hours, this acciclent has }1" ·ned. when it c()ndition was almost inevitable. nllght h~ assumed_' that the patient • ow, let us make quite sure that \V0ujd have been removed to hos\ .:: e' clear on every point as we go pital and would thft') b~ I '\.-_ along. What is a ' syndrome'? A medical c<' re t I, I 1._(,,, ~sary for , syndrome' is a collection of signs the fir ,t '-lid",[ lo know anything of and symptoms which medical men ~hc aetiology or pathology of the have observed occur together wjth condition. There are, however, two unfailing regularity and always destrong arguments against this sugnote a certain disease or morbid gestion. First, it is possible for tbe condition. patient to have been trapped in that position, and to have remained so, Nineteen Cases at Messina in 1909 undiscovered, for over an hour, by It is interesting to note that the which time the condition might 'crush syndrome' as such was possibly have commenced to develop. almost unknO\vn to British surgeons On the other hand, even if the up to 1941, although Dr. Bywaters, arrival of the first-aider did anticipate who was afterwards recognised as an authority upon this class of condithe development of the 'crush tion, tells us that it was well-known syndrome,' it would naturally be his to the Germans in the first world war, aim to prevent its development. A and cases ha ve been reported from knowledge, therefore, of possibilities time to time following mine diswould enable him to apply a far asters. The first world war did not, more intelligent preventive treathowever, constitute its first recogniment than would otherwise be tion, for in 1909 nineteen cases were possible. The importance of this described in the great earthquake of preventive treatment is all the more Messina. Today, when patients are fully appreciated when figures showsubject to much closer observation ing the percentages of recovery are than formerly, it is noticed that studied. During the course of an oliguria (diminished urinary output) investigation carried out by the is the outstanding symptom, and Medical Research Council, in which

thi~,

if not successfully treated, qUIckly develops into anuria (complete s~ppress~on of urinary output) , the patIent dymg 7 or 8 days later of uraemia, or poisoning by the toxic substances which would otherwise have been carried off in the urine. ~emarkable as it may appear, the patIent, when first discovered, does not appear to be experiencing very much distress. Indeed, I have known more than one case in which he actually joked about his plight. He will, however, admit that at first there was considerable pain, but he will state that, after a time, the pain abated until eventually it occasioned him small discomfort. This did not necessarily mean that all sensation had been lost, for a fresh stimulus, like a pinch or a pin-prick, would produce the normal reaction. The pulse is found to be normal, there is no apparent oedema (swelling) and, if a doctor be present, he will probably find that the bloodpressure is also normal. Signs and Symptoms It is not until the patient has been released that attention is directed to any special phenomena, and for this reason it has been suggested that 'release syndrome ' would be a more appropriate name. Even then these special signs and symptoms may not be observed until long after he has been admitted to casualty. On the other hand bis release may immediately herald the change for which any experienced surgeon would be looking. The limb will commence to swell as the result of the extravasation of either plasma or whole blood into the damaged tissues, and this loss of fluid from the circulation will be followed by shock. The swollen limb becomes hard and icy cold, and the pulse may altogether disappear from the distal part, although it may still be discerned at the brachial or the femoral as the case may be. Weals and petechial (small, spotty)

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957 11

haemorrhages will probably appear at the site of compression, followed by a greater or lesser degree of paralysis. If he remains conscious he will probably complain of pain in the loins, at the level of the kidneys, and there may be nausea and vomiting. Gradually the mental condition becomes dull and apathetic, and sooner or later he will lose consciousness completely. Inability to Urinate I have left until last the most significant symptom of all, and that is the condition of the 'waterworks.' This should receive attention from the moment the victim is discovered, for it will probably be found that he is either unable to pass urine (anuria) or can pass but a very small quantity (oliguria), and this constitutes a very grave condition. It should be reported to the surgeon as soon as he arrives, but in the meantime the first aider must himself take immediate action. Incidentally, if any urine is passed at all, try to obtain a specimen, for this may prove very valuable to the surgeon later when he attempts to make his clinical diagnosis. Physiological Cause Perhaps this would be a convenient place to interrupt this discourse to explain the physiological cause of this suppression, for I contend that the first aider cannot learn too much if it will assist him to render more efficient treatment. It is not necessary to describe in detail the anatomical structure of the kidney, a mere outline being sufficient to enable you to understand what takes place in it, and what has gone wrong in the case of the' crush syndrome.' The shape of the kidney is well-known, and might be compared with that of a broad bean, the inner border being called the 'hilum.' This receives the expanded end of the ureter, a thin tube leading down to the bladder, but of this more later. 'Pelvis' is the name given to this expanded end. The body of the kidney consists for the most part of millions of long, thin microscopic U-shaped tubules, collected into tapering bundles called 'pyramids,' and with their pointed ends opening into the pelvis, or funnel-shaped upper end of the ureter. These tiny tubLLles commence as small swellings near the outer border (cortex) of the

kidney, traversing the body of the organ from cortex to pelvis. The swelling referred to is really an expansion into a funnel-shaped receptacle called Bowman's capsule which contains a bunch of microscopic capillaries (glomerulus, plural glomeruli) terminating one of the branches of the renal artery which entered the pelvis from the aorta. To describe the function of the kidney as that of purifying the blood would be not only inaccurate but misleading, as I would immediately be reminded by those of my readers who had learned their circulation thoroughly that this process takes place in the lungs. Rather should it be stated that in the kidneys certain waste products of metabolism are separated from the blood and excreted in the urine, and it is at the point we have now reached, the glomerulus, that, by a process of filtration, this separation takes place. These waste solids, consisting chiefly of urea, uric acid, urates, chlorides, phosphates and oxala tes, are then conveyed in the urine by the ureters and the bladder and eventually expelled from the body. Result of Obstructiun Now it must be obvious that if anything occurs to cause an obstruction in the minute urinary tubules, and to interfere with the passage of the urine, the waste solids which have been collected from the blood, some of which are more or less toxic, must accumulate elsewhere. This is exactly what does take place, and the blood, which should have been relieved of the waste substances, becomes poisoned, resulting in a condition known as uraemia, which can very quickly prove fatal. Several theories have been advanced to explain the processes leading to the blockage of the urinary tubules, but the one which is now generally accepted is that of Bywaters. He has shown that when muscle tissue is damaged as in the case of crushing, it releases a substance called myohaemoglobin which, whilst normally serving as a temporary storage for oxygen, can cause considerable damage when out of its normal sphere. When released from damaged muscle into the surrounding tissues, it quickly finds its way into the bloodstream, then into the glomerulus and eventually into the uriniferous

tubules. Now, myohaemoglobin is insoluble, or almost so, in an acid environment, and as the reaction of normal urine is acid, when it gets into the tubules it not only forms an obstruction itself, but it also damages the epithelial walls of the tubules. Treatment It will be obvious from this that the first object of the surgeon when he arrives is to remove this obstruction, and the only way in which this can be done is to render the urine alkaline. This can be done by· administering an alkali, and the doctor upon arrival will give this in the form of an intravenous injection. In the meantime the first aider can render most valuable assistance by giving an alkali by mouth. Should you be fortunate enough to be within easy reach of a chemist, then a mixture of sodium citrate and sodium bicarbonate (one teaspoonful of each) in an ounce (two tablespoonfuls) of water is recommended, but if the sodium citrate is not available, then use the sodium bicarbonate alone, and this solution should be given ad lib. If no alkali at all can be obtained, then copious draughts of fluid-tea, or even water will be better tb~tl nothing at all, as it will promote dilutiu;-l, It is most essential that diuresis ShCllld be re-established as soon as possible - ' get the waterworks going.' The treatment of the renal condition must not obscure the necessity for treating the local conditions, and as early as possible a tourniquet or, better still, an elastic bandage should be applied round the limb as near to the body as possible, in order to prevent further passage of toxic substances towards the kidneys. An elastic web bandage commenced at the distal end and carried up the limb will help to prevent further swelling and minimise shock. Needless to say, care and experience are necessary in applying both, for neither of them must be too tight. Cold compresses ,will help to keep the wounds, which should be dressed in the uSLLal manner, cool by evaporation. All the above treatments should be commenced without waiting for the patient to be released, and should be continued during the process or release, but this does not mean that release must be delayed on this account.

Heat must NOT be applied to the wounds and alcohol MUST BE AVOIDED. Perhaps there are few types of injury ill which care in documentation is more important. The card should bear, in a prominent position, 'X', which will attract immediate attention in casualty and secure

priority, and 'T' (for 'tourniquet'). The time the tourniquet was applied should be recorded, and the times, if any, that it has been released. Make a note of the alkali which has been administered, and state the quantity taken by the patient. If morphine has been injected by the doctor (and this is almost certain if

the patient has been in pain) ask him the quantity he has given and mark the card accordingly, prefixed by a prominent 'M' . Haemorrhage should be indicated by 'H'. Finally, 'X', 'T', 'M' and 'H' should be marked on the forehead of the patient. Nail varnish is useful for this purpose.

THE CIRCULATORY SYSTEM by a State Registered Nurse THE circulatory system consists of the blood and the organs concerned in the circulation, namely the heart, the bloodvessels and the lymphatics.

BLOOD Blood is composed of two parts the Auid, known as plasma, and the blood 'cells. The plasma is a yellowish fluid containing protein and salts. ~lood cells are of three types, red, whIte and platelets. The red blood cells contain haemoglobin which gives the blood its colour. They are also responsible for carrying oxygen to the tissues. Each cubic millimetre of blood contains approximately 5,000,000 red blood cells. White blood cells help to overcome infection and th~y have the power to ingest living organisms which invade the body. They number approximately 8,000 per cubic millimetre of blood. Platelets are much smaller in size than the red and white cells and average 350,000 per cubic millimetre of blood. They are thought to be concerned in the clotting of the blood. FUNCTIONS OF THE BLOOD (1) To act as the transport system of the body, conveying chemical substances requi red for the nourishment of the tissues . (2) The red cells convey oxygen to the tissues and remove some of the carbon dioxide. (3) The white cells provide many of the protective substances to protect the body from harmful germs . (4) The plasma distributes proteins needed for tissue formation. It provides the tissue fluid by which all cells receive nourishment, and it removes waste matter, conveying it to the various excretary organs for elimination.

(5) The internal secretions, hormones, and enzymes are conveyed from organ to organ by means of the blood.

THE HEART The heart is the great pumping organ, maintaining the circulation throughout the body. It is !' cone-Shaped, hollow muscular organ, havmg the base above and the apex below. The apex inclines towards the left side. The heart lies in the thorax, between the lungs, and behind the sternum and is directed more to the left than to the right side. It is about the size of the clenched fist and the normal adult heart weighs from eight to nine ounces. A partition known as the septum divides tbe heart into left and right sides. These two sides are further divided making four chambers, two above which are known as auricles and are receiving chambers, and two below which are known as ventricles and are the distributing chambers. Each auricle communicates with its fellow ventricle by means of an auricular-ventricular opening which is guarded by a valve. The valve guarding the right auricular-ventricular opening is known as the tricuspid valve while the valve guarding the left opening is known as the bicuspid or mitral valve. When closed the valves form the floor of the auricles. The valves permit the passage of blood in one direction only, from the auricle to the ventricle. The interior of each of the ventricular walls is marked by thickened columns of muscle. Some of the muscles have small prominences or papillae, known as papillary muscles, to which are attached thin tendinous cords. The other ends of these cords are attached to the lower bOI d ~rs of the auricular-ventricular valves to prevent them being forced up into the auricles when the ventricles contract. Each ventricle holds approximately three ounces of blood and the auricles hold slightly less.

The heart itself is supplied with blood from the two coronary arteries, which are the first branches of the aorta. These two arteries then divide into smaller arteries which encircle the heart and supply blood to all parts of the organ. The blood returns directly into the right auritle, mainly by means of the coronary sinus. The heart consists of three layers;(a) The pericardium or outer covering. (b) The myocardium, the middle muscular layer. (c) The endocardiwn, the inner layer or lining. The walls of the ventricles are thicker than those of the auricles as the ventricles, being the distributing chambers have more work to do . The walls of the left ventricle are thicker than those of the right.

BLOOD-VESSELS There are three types of blood-vessels;(a) Arteries, which carry blood from the heart. They have three coats, the middle one being muscular and elastic. (b) Veins, which carry blood to the heart. These also have three coats but the middle one is Jess elastic and more collapsible than in the arteries . (c) Capillaries, uniting arteries and veins and forming the' capillary lake, ' where the traffic between nourishment and waste matter proceeds and the interchange of gases takes place. LYMPHATICS Lymphatics may also be regarded as part of the circulatory system because the lymph, which has passed through t~e capillary walls to feed the tissues, IS collected, filtered, and passed back to the blood stream by the lymphatic system . Lymph is a part of the blood serum. Lymphatic vessels are similar to small veins while lymphatic glands are small ovaJ glands placed in the course of the lym-

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

12 pbatic vessels. The glands contain white blood cells, which as previously stated, help to overcome invading organisms.

Compiled by W. A. Potter

Literature available 10 members of

tfle Medical and allied professions only.

Local Superficial Amesthesia

28. 29.

ACROSS Transfusion at the local! (1, 4, 2, 3, 4) Indication of sl'rious loss of blood (3, 6) Special edition (5) A 100 chop to masticate (4) Describes Anaesthetics like ether and trilene ... ... (10) A rise is lost in my unhappiness (6) Removed surgically ... .. . (7) It looks bad. I'm back to nothing before we French ... (7) Flush out body cavity... . .. (6) Bleeding from placenta during pregnancy . . . . . . (10) To be tucked away by the firstaider ... ... ... (4) Decorative on ('~nfectionery; dangerous on aircraft ... (5) Inability to empty the bladder (9) Symptom:ofvitamin A deficiency (5, 9)

DOWN Evacuate the bowel by drugs ...

9. J 0_ I 1.

14. 16_ 18. 20.

22.

ANSWERS 1. Eight bones arranged in two rows offoUT. 2. By the junction of two or more bones. 3. The rounded head of one bone fits into the cup-shaped cavity of another bone. 4. Two groups. Voluntary and involuntary. 5. The heart and lungs. 6. The outer. or hard layer (cuticle) and the Inner layer (true skin or dermis) . 7. The diaphragm. 8. A covering applied to a wound or to an injured part.

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THE GENERAL OR SYSTENUC - CIRCULATION The blood leaves the left ventricle of the heart by the aorta, which is the largest artery in the body. The aorta breaks up into smaller arteries which carry the blood to different parts of the body. These arteries divide and sub-divide until very small vessels called capillaries are formed. It is through the capillary walls that the blood gives up oxygen to the tissues and receives carbonic acid gas in exchange. These capillaries unite to form veins which carry the blood back to the heart. The veins, which are small when formed by the capillaries, unite until finally two large veins are formed, the inferior vena cava, which collects blood from the trunk and lower limbs and the superior vena cava, which collects blood from the head and upper extremities. These two vessels empty their contents into the right auricle of the heart. The blood is then passed through the valve into the right ventricle. The ventricle contracts and the blood is forced into the pulmonary artery which divides and carries the blood to both lungs. Here the small arteries divide and subdivide to become capillaries which surround the air cells in the lungs. Through these capillary walls the blood gives up the impurities received from the tissues, and receives oxygen in exchange. The capillaries, as in o~her parts of the body, unite to. form veins which eventually form the four pulmonary veins by which the blood is returned to the left auricle of the heart. It then passes through the valve into the left ventricle of the heart. The pulmonary arteries are the only arteries in the body which carry impure blood and the pulmonary veins are the only veins which carry pure blood.

FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

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Commonsense. .. ... ... (4) Groans from parts of body performing specificfunctions ... (6) Row of houses with high end... (7) Perhaps a better method for obtaining the same result as 2 (5) Factor necessary for normal formation of red blood cells... (9) Present raid on this valuable fellow... ... . .. . .. (7, 6) Adjustment of lens tor near vision ... (13) Riotfor3 (4) Surgical procedure makes irritation in sting... ... ... (9) Its disturbance may cause secondary haemorrhage (4) Commonly prescribed for insomnia (7) Unrestrained ... (6) Finger! in. (5) Modified epidermis for the carpenter ... (5) Try an article on soon... (4)

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FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

given little and often. If the bleeding recurs an immediate operation may become necessary in which the ulcer and part of the stomach is removed. This operation-called a partial gastrectomy-gives a satisfactory result.

~"der~

queries Answered by Dr. A. D. Belilios A. A. (Brighton) writes:The St. John's Manual te11s us that a grave complication of a fractured spine is injury to the spinal cord which results in loss of power and sensation in all parts of the body below the site of injury. Will Dr. Belilios please explain why this should be. Answer A brief explanation only is possible. The spinal cord contains long columns of nerve fibres which act like telephone cables and carry messages (nerve impulses) between the brain and all parts of the body. Some of these impulses induce movement of muscles while others convey sensation. If these columns are damaged by pressure or injury by the fragments of a fracture, their function is naturally disturbed or destroyed.

S. T. (Edinburgh) writes:I know this is not a true first aid question but what treatment does the doctor undertake for vomiting of blood caused by a gastric ulcer. Answer Complete rest achieved by glvmg an injection of morphia or similar drug, starvation and blood transfusion. As the patient improves, a simple and easily digest~d diet is

J. G. (Basingstoke) writes:One of the workers in our factory tells us that she has had a big operation done on her chest for consumption, called a lobectomy. Can you tell us what this operation involves, her chances of recovery and whether she will be able to )\lark with us again without danger of spreading infection. Answer It is not possible to answer your question with certainty without fuller knowledge of the case. Often tuberculosis is confined to one lobe of a lung. If this lobe is removed by the operation called lobectomy, naturally the patient can be regarded as cured. Frequently, however, there are other tuberculous areas in other lobes. These, however, tend to heal up once the largest area affected has been removed. The results of lobectomy are often extremely satisfactory.

R. B. F. (Tonbridge) writes:I have seen several advertisements in newspapers advcr!ising methods of preventing Asian 'flu. These include sniffing up the nose a solution of disinfectant, gargling twice a day, and taking vitamin pills. I shall be very grateful if Dr. Belilios would give us his views on these and other methods of preventing this ailment. Answer I have very little faith in sniffing antiseptic solution up the nose or

Miscellaneous Advertisements should be .erit to First Aid & Nurslnr, 32 Fin.bury Squ&re, London, E.C.l. Rate 4d. per word. minImum 6.. Box number. Is •• xtra.

SCENT CARDS. 250 18 /6, 1,000 52/6. Tickets, Printed Pencils Memos . Samples free.-TICES, 11 Oak lands Grove, London, W.12. ' OUR NEY': series of F.{\.. competition papers now ready. Team tests five for 5/6. ~ndlVldual tests eIght for 5/6. Selby & Plowright 135 Russell Street Kettermg. " ALVASTON ~. DISTRICT S.J.A.B. Derby. 10th Annual Bower Cup Open Adult CompetltJon, 9th November 1957. Entries on plain paper to W Garbett 27 Severn Street, AlvastoD, Derby. not later than 2nd November. Entrance fe~ 10/-. Team test only. ~ndividual optional 1/-. per member. Excellent prizes. Rules forwarded on receIpt of entry form. DIVISIONAL <;UR GEON'S Outfit S.J.A.B. Good condition. Box No. 776, ' First Aid London, E.C.2.

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gargling as preventive measures. Taking vitamins may increase bodily resistance but in my view has only a limited value. Injections which have now been produced seem (although only available for doctors themselves and hospital staff) to be the most hopeful line of action. V. H. B. (Edinburgh) writes:I know this question is not strictly speaking first aid or home nursing but I would be grateful to have a definition of the word 'paras;re.' Answer All questions dealing with medical work are welcome in this column. A parasite is an organism, animal or vegetable which lives on or in another creature and from which it obtains its nourishment. Examples in the case of the human being include worms, lice and fleas.

G. H. (Maidstone) writes:Treatment of Concussion and . Compression Could you kindly obtain a ruling on a controversial point regarding the special treatment of concussion and compression and which has been discussed by members of my Force in connection with first aid training. In supplement No.3, Rule No.2, it states: 'Apply cold compresses to the head, taking care to avoid wounds.' In the 40th edition, 10th impression, in which the supplement is now embodied, under the heading of Special Treatment for Concussion and Compression no reference is made to the application of cold to the head. It will be appredated if advice could be given as to whether or not cold compresses should continue to be applied in these particular injuries.

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FIRST AID & NURSING, SEPTEMBER/OCTOBER 1957

J would like to add that the articles and comments on first aid which appear in your journal are very much appreciated.

Answer A very good case- and by the way, let us have some more interesting ones when you meet them. The cap had obviously been inhaled and passed down his air passages , until it lodged-as is not uncommon-in the right bronchus. Removal would

Answer In my view it is very unlikely that cold compresses can do much good in concussion and compression. The treatment has been recommended for many years but when it is realised that when the cold from the compress has to penetrate the hair, skin, scalp muscles, bones and coverings of the brain before it reaches the brain itself, it will be appreciated that it can only have a very limited effect.

be undertaken by using a bronchoscope. This is an illuminated tubular instrument which can be passed down the air passages while the patient is under an anaesthetic. When the foreign body has been located, it can be removed by spedal forceps.

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L. K. S. (Nottingham) writes:I ran into an interesting case recently. A young man was holding the plastic cap of a collapsible tube in his mouth when someone made him laugh. He developed a severe fit of coughing and found afterwards that the cap had disappeared. A doctor advised by telephone his immediate removal to hospital where he was detailled. The cap was removedfrom his right bronchus the next day. How could this be done, please?

women throughout British Railways are now enrolling for the winter session of instruction in first aid, and over 20,000 are expected to qualify, including some 4,000 for the first time. First aid classes are held every year in all regions of British Rail ways and classrooms, with the necessary heating and lighting, text-books, and first aid equipment, are provided free. British Railways also pay the expenses of the ~octors and qualified instructors, and give free travel to students who attend classes away from their home station. Competitions, to raise the standard of efficiency and to foster interest, are held annually within the regions, and between the regions, including London Transport; there are also separate competitions for women and for British Transport Police. Improved Recognition To encourage even more staff to participate in the first aid movement, British Railways have improved the recognition granted to staff who qualify. One addi-

tiona I day's leave with pay is now granted on passing the third, instead of the fifth, and each subsequent examination, and two additional day's leave with pay on passing the fifteenth, instead of the twentieth, and each subsequent examination. A free ticket available over any part of British Railways, will continue to be given on passing the first and subsequent examinations. Movement Began in 1878 The first aid movement among railway employees began at Paddington Station in 1878, only nine months after the formation of the St. John Ambulance Association, and has steadily grown. Today, railway staff skilled in first aid are to be found in almost all grades and at most stations and depots . They perform an invaluable service as their training enables them to assist in almost any emergency, whether at their place of work, in the streets, at home, or elsewhere. There are many instances of injuries millimised and lives saved by prompt and efficient first aid work by trained railwaymen.

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Twelve months ago an entirely new idea for First Aid ':fra~ning called" PLASTIFOL " was introduced and very enthuslasucally received by all concerned with training programmes. Previously casualty faking made use of modelling clay. and grease paint. Although effective, it was found that a consIderable amo~t of time was wasted in modelling the wounds as they were so qUlckly damaged when treatment and b~ndaging. took I?lac~. The Wound Replicas are made of soft PlastIC matenal WhICh IS washable a~d lasts indefinitely. They can be temporar~ly attache.d to ~e SkIll with gum and used over and over agam. Dunng this year additional Replicas have been developed covering a wider range of injuries and a more comprehensive set containing 18 different replicas and known as the No.2 SET is now available. The use of these will add further interest to training courses. Sample axe wound, illustrations and notes may be obtained, postage paid, by sending remittance for 3 /6d. BROWNING'S

TELEPHONE: MUSEUM 2703

Nineteenth Edition. Completely revised. 261 st thousand. 286 pp., 286 illustrations, some coloured, 65. 6d., post 4d. WARWICK AND TUNSTALL'S

FIRST AID

STAIRWAY TROLLEY SHOP

Write for further details and prices.

G. McLOUGHLIN & CO. LTD. Dept. F.A., VICTORIA WORKS, OLDHAM RD., ROCHDALE, LANeS. RDchd!~ ~977

Regulation Unifornl for

OFFICERS

TO THE INJURED AND SICK Edited by A. P. GORHAM, M.B., Ch.B., M.R.C.S. Police Surgeon . City and County of Bristol

FIRST AID' WALL DIAGRAMS 26 X 40 in. I

A- G H-J K, L M, N 0,P Q, R. S, T

METHODS OF ARTIfiCIAL RESPIRATION

Anatomy and physiology. The triangular bandage. The roller bandage. Haemorrhage and wounds. Dislocations and fractures. Transport. Artificial respi ration .

Single Sheets: Linen - 75., plus postage. Paper - 55., plus postage. Set of 20, on Roller: Linen - 1505., post free. Paper -IOOs., post free.

The British R.ed Cross Society have specially adopted a set of 6 sheets, A, D, M, N, 0 , P, which can be supplied on linen with fittings for the special price of 505., plus postage.

JOHN WRIGHT & SONS LTD., BRISTOL

MEMBERS

(Female onLy) OF THE

ST. JOHN AMBULANCE BRIGADE We have specialised in the making of Nurses' Uniforms for nearly 100 years and have a reputation for good quality materials and superb workmanship. You can order your St. John Ambulance Uniform with confidence, knowing tbat every detail will be in accordance with regulations. We shall be pleased to send full details upon request.

I~~~~== E. 150-162

DEPT. Fl-69 ABERDEEN STREET, HULL, ENGl.-AND.

YheBROADLEY Designed for easy handling up and down stairways. This entirely new design of hospital trolley can be loaded with a full day's supply, the load being varied by adding or removing trays. Goods always visible to patient and accessible to attendant at the same time.

LTD.

for the

& R. GARROULD LTD. ~~~~21 EDGWARE

ROAD,

LONDON,

\v.2

BAILLIERE BOOKS ~FOR ' FIRST ' AlbE~S A HANDBOOK OF

ELEMENTARY NURSING Arthur D. Belilios, M.B., B.S., D.P.H., and Dorothea Duncan-Johnstone, S.R.N. This handbook is the ideal guide for anyone who is called upon to carry out any form of emergency nursing. ~t describes in simple language the bas!c principles and procedures that unde~he the science of nursing, and contalOs brief descriptions of the more common diseases, with general notes on the nursing required in each case. A complete chapter is devoted to the subject of home nursing, and the whole book provides for every first aider the essentials of nursing in a handy yet comprehensive form.

With 324 pages and 61 drawings 7s. 6d. Postage 9d.

Bailliere, Tindall and Cox

BAILLIERE'S HANDBOOK OF

FIRST AID AND BANDAGING by Arthur D. Belilios, M.B., B.S., D.P.H., D. K. Mulvany, M.S., and Katharine F. Armstrong, S.R.N., S.C.M., D.)!.

F.R.C.S., F.R.C.P.I.,

First aid books, as a rule, confine themselves to injuries, e.g. fractures, wounds, burns, scalds, etc. This volume is far wider in scope. It covers medical conditions of all kinds, and much of the information is not to be found easily elsewhere. There are chapters on case-taking, medical causes of unconsciousness, internal haemorrhage, first aid in maternity cases, first aid in spinal injuries, asphyxia, industrial poisoning. the use of morphlOe. 'Undoubtedly the best of its kind.' Nursing Mirror. Fourth Edition. With 476 pages and 200 drawings. 8s. 6d. Postage 9d. Bailli~re, Tindall and Cox Ltd. OR 7-8 Henrietta Street

Dale, Reynolds and Co. Ltd. 32 Finsbury Square

London, W .C.2

London, E.C.2

................ copy/ ies of A Handbook of Elementary Nursing Please send me { ............ ... copy/ies of First Aid and Bandaging for which I enclose remittance of. ........ .. ............. (Postage 9d. extra per volume.) Name ....... .... ......................... . Address ............ ..................................... .

A NEW ALL-METAL 2-STRETCHER A BULANCE ON THE • W/B CHASSIS In. LAND ROVER I

&: NURSING NOVEMBER/DECEMBER 1957

HIS up-to-dato:_ ':lmbulance incorporates the latest aluminium alloy construction techniques to combine toughness with comfort, and has all the mobility and

tenacity afforded by a 4-wheel drive. The design provides for two stretchers and an attendant, one stretcher an d three sitting cases, or six sitting cases. Features include built-in wash basin with water supply, fully insulated body for tropi~al use, and adequate locker accommodation. You a!"" invited to apply for full details of Mobile Medical Units, Ambulances, etc., built to your particular requirement!; for service in any part of the world.

PILCHERS

AMBULANCE & MOBILE UNIT BUILDERS

314 Kingston Road, Wimbledon, S. W.20 Telephone: LiBerty 2350 & 7058

47 High Path, London, S. W .19 Telephone: LIBerty 3507

Printed b:y HOWARD, JONES, ROBERTS & LEETE, Ltd., 26-28 Bury Street, St. Mary Axe, London, E.C.3, and published by the Propnetors, DALE, REYNOLDS & CO ., Ltd., at 32 Finsbury Square, London, E.C.2, to whom all communications should \;Je addressed.

PRICE FIVEPENCE 3/6 per Annum Past Paid

UNqUESTIONABLY

remedy. It is already in widespread use by the medical and nursing professions in many parts of the world.

THE REMEDY

TO PUT ANTIPEOL TO THE TEST, send for your free clinical sample.

SKIN INFECTIONS are primarily caused by Staphylococci, Streptococci and B. Pyocyaneus. A really effective ointment must therefore strike at these micro-organisms.

ANTIPEOL is an essential component of every First Aid and Nursing Kit.

ANTIPEOL CUTANEOUS OINTMENT incorporates the sterile broth filtrates of the three infective microbes in an ointment base of proved efficiency. AS A TREAT MENT for burns and scalds, ANTIPEOL OINTMENT is both non-adhesive and bactericidal, thus obviating the need, when not convenient, of changing the dressings every day. FOR CUTS, ABRASIONS, BOILS and numerous skin infections, ANTIPEOL is unquestionably the

an ipeo .

cutaneous ozntntzent Produced by the makers of:

ENTEROFAGOS for intestinal complaints. RHINO-ANTIPEOL for naso-pharynx infections. OPHTHALMO-ANTIPEOL for ocular infections. DETENSYL for reducing arterial tension.

HED 0 - BIOLOGICAL LABORATORIES LTD., CARGREEN ROAD, SOUTH NORWOOD, S.E.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1957

UNIFORMS and LADIES~ GREAT fJOATS & fJOSTUMES

First Aid

MEN~S

for Divisions of the St. John Ambulance Brigade and also the British Red Cross Society can be obtained from

Nursing

January 24th

Diseases of the Heart

'Phone:

What Do You Know?- No.3.

New Resuscitator

The London Nursing Exhibition .. .

Competitions .. .

From a Seat in the Audience

'Grams:

"Hobson, Sedist, London "

PATENT

"PORTLAND"

In this Issue

First-Aider's Crossword No. 31 l4 Readers' Queries

AMBULANCE GEAR

no you know

The Gear iIlustrated(A.B.C.D.) carries two stretchers on one side of Ambulance, leavi ng other side clear for sitti ng patients.

that . •. The cell from which a human foetus develops is only l ' I20th of an inch in diameter ?

The UP AND DOWN action is quic'k and easy for loading or unloading. A. Shows the two stretchers in position.

There are thrce kinds of bacteria which are not destroyed by the normal sterilising methods, viz., the spore-bearing tetanus, gas-gangrene and anthrax?

B. Shows the top stretcher lowered read y for loading. C. Illustrates the same Gear with the top stretcher frame hinged down for use when only one stretcher case is carried. D. Shows the same position as in .. C " only with cushions and back rest fitted for convalescent cases.

Chlorophyl, the green colouring matter of plants, is often used in the treatment of anaemia ') 45 dealh , occU', cd eve, y day last year as the re· ult of a ccidents?

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

Men who, in their younger days, have indulged in excessive athletic sports, are, in later years, more likely to suffer from fatty degeneration of the heart than others?

_________________,J

Full cota/ogue of Ambulance Equipment Nc.7A will be sent on request.

65, WIGMORE STREET, LONDON, W.I 'Phone I WELbeck 0071

March 26th March 29th

May 10th May 16t.h June 4th

UNIFORM CLOTHING AND EQUIPMENT MANUFACTURERS LONDON BRIDGE 154 - 164 TOOLEY STREET S.E.1 Hop 2476 (4 lines)

February 27th March 15th

May 10th May 10th

Nov. IDee. 1957

HOBSON & SONS (London)

Reeognition has been \Von The Fellowship Diploma of the Institute of Certified Ambulance Personnel has now been recogmsed by all local authority ambulance services in England and Wales. In ~nn.ouncin~ this impor.tant advanc(the Institute recalls that in its eleven years eXIstence It has kept III the forefront of its aims the need to increase the sta~~s of ambulance personnel through training and examination. This recogm.tIOn reached after months of negotiation, is the first step towards full profeSSIOnal status for ~mbul~nce and industJjal first aid personnel.

4 per cent. of all babies born do not reach the age of twelve months?

June 20th June 29th July 12th September 26th Octo ber 10th November 13th November 27th

1958 Forthcoming Events Metropolitan Police Finals (' Parsons' Shield '), McNaughton House, Gray's Inn Road. Po~~e National Finals (the' Pim '), Porchester Halls. Bntlsh Red Cross Society Women's Eliminating Rounds, Headq uarters, Grosvenor Crescent and Monument. (Admission only by special invitation.) British Electricity Finals, Porchester Halls. British Red Cross Society Men's Eliminating Rounds, Headquarters, Grosvenor Crescent and Monument. (Admission only by special invitation.) Miners' National Finals, Blackpool. British Red Cross Society Finals (' Stanley' Shields) Friends' House, Euston Road. ' Girls' Life Brigade Finals, London. U.K. Atomic Energy Authority Finals, Aldermaston, Berks . B.T.C. (Railways and Docks) and B.T.C. Police Finals. Central Hall, Westminster. Ministry of Supply Finals, Friends' House, Euston Road . National Road Passenger Transport Finals, Aldenham, Herts . National Dock Labour Board Finals, Queen Mary College, London, E.l. Fire Brigades Finals, Torquay. Gas Industry Finals, Friends' House, Euston Road. G.P.O. Finals, Porchester Halls. Gran~ Prior's Trophies, Porchester Halls. The Duke of Edinburgh's Award

Mountain Ash (Glam.) Y.M.C.A. has become the first organisation in Wales to win awards under the Duke of Edinburgh's scheme for hobbies, public service, adventure, and first aid, etc. It is also the only organisation in the country to win eight certificates. The certificates were presented to the eight boys by Lord Aberdare, who was attending his first public function in Wales since succeeding to his title. He presented certificates to Lloyd Evans, Geoffrey Hawkins, Brian Maggs, Ken Phillips, Carl Sullivan, Brian Smith, Thomas Stephens and David Thomas. Member .. of first aid and nursing organizations along with parents and a la rge gathering of the public witnessed this occasion.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1957

A Course in Elementary Medicine

Diseases of the Heart By A. David Belilios M.B., B.S. (Lond.), D.P.R. (Eng.)

of articles on diseases I N ofthistheseries heart and circulation, we have not yet dealt with affections of the smooth endocardium which lines the inside of the organ and is particularly prone to inflammation and other changes. It is the endocardium which cover's the valves of the heart that is most likely to be affected hence it is desirable to begin this article with a brjef account of these structures. It will be remembered that the heart is divided from its base to the apex into two distinct halves, the right and left sides of the heart respectively. Each half is divided into two chambers or cavities, the auricle or receiving chamber and the ventricle or discharging chamber. There are openings between the right auricle and ventricle and between the left auricle and ventricle but none between the opposite sides of the heart. The openings between the auricles and ventricles are guarded by valves whose function is to permit blood to flow from auricle to ventricle but to prevent it flowing from ventricle to auricle each time the heart beats. The valves are not unlike parachutes in appearance and comprise flaps with cords which join them to muscular projections arising from the ventricles. The flaps are made of fibrous tissue and are covered with endocardium. A full description is not possible in an article of this size and text books which include anatomy and physiology that are illustrated should be consulted by readers who want to know more about the valves than is above described. Further sets of valves are found at the beginning of the aorta and pulmonary artery. Their flaps are not quite sinrilar in appearance but they are lined by endocardium. Their function is to permit blood to leave the heart when the ventricles contract but to prevent it returning when the heart has its little rest between each beat.

Endocarditis Acute endocarditis is responsible for many of the chronic cases of heart disease that occur in later life. It can be due to many causes such as rheumatic fever, tonsillitis, scarlet fever and similar ailments. It generally attacks the valves which become swollen and inflamed. 'The symptoms and signs are usually vague since they are hidden by the causative ailment. They may include, however, palpitations; shortness of breath, a raised temperature and a rapid pulse. The outcome is generally favourable, the patient making a quick and complete recovery although sometimes he is left with permanent cardiac damage as will be seen later. A variety of the acute form which is much more serious is called infective endocarditis. It is generally due to a germ-tl e streptococcusand attacks hearts which have already been subjected to a previous attack. It affects the valves which in addition to becorrring inflamed frequently develop on their cusps small finger-like projections called vegetations. There may also be ulceration and destruction of the valves themselves. Characteristics include high temperature, sweating, attacks of shivering and progressive wasting. The patient becomes anaemic as is shown by his pallor. Occasionally portions of the vegetations break off and enter the genel al circulation. In this event, they are carried in the bloodstream and ultimately lodge in vital organs such as the brain where they cause a variety of apoplexy (cerebral embolism), the kidney, caus;ng pain in the loin and blood in the urine or under the skj n causing small haemorrhages. It will be readily understood that infective endocarditis is a very serious ailment but the outlook has been considerably improved by the use of penicillin and other antibiotics.

Chronic endocarditis This may result from one or more acute attacks or develop gradually as an independent ailment. It is the valves of the left side of the heart that are chiefly affected; they become thickened, shrunken and scarred, losing their normal elasticity. Since it is the valves which are chiefly \affected, the disease is often called valvular disease of the heart. The mitral valve situated between the left auricle and ventricle is most prone and produces the two conditions called mitral incompetence and mitral stenosis. These must be carefully described. Mitral incompetence When a normal heart beats, the left ventricle pumps blood into the aorta. The flaps of the valve meet together in such a manner that they form a perfect barrier and prevent blood flowing back into the auricle. If, however, the valve has been affected by disease, its flaps may not meet completely in which case it is said to be incompetent and some of the blood which would normally have flowed into the aorta is now pumped back into the auricle through the small aperture which exists through the flaps not meeting properly. The flow of the blood through th is small aperture causes a gushing sound called a murmur which can easily be heard by a doctor with his stethoscope. It can be likened to the sound which occurs when water flowing in a stream passes through a narrowed portion. The effect of mitral incompetence is that the body does not receive its full quantity of blood at each beat while the auricle receives a small quantity from an abnormal source. But this does not necessarily affect the health of the individual since the human body is so well constructed that it can deal with difficulties of this kind. The auricle soon discharges into the left ventricle more than the

FIRST AID & NURSING, NOVEMBER /DECEMBER 1957

normal quantity of blood and the ventricle similarly pumps more blood into the general ci rculation. Naturally both these chambers of the heart have to work harder to undertake this task and consequently their muscular coats become thicker or hypertrophied as it is called in technical language. The heart thus becomes enlarged but this again is not of serious significance, This process of hypertrophy of the left auricle and ventricle overcomes the difficulties above described or again put into technical language, compensation takes place and the body experiences no ill effects. So long as the heart remains well compensated, therefore, the patient remains in good health although perhaps a little restricted in his activities. He may easily hve to ripe old age and ultimately die from a totally different illness. It is most important that this should be thoroughly understood. Some sufferers from valvular disease of the heart cause themselves no end of unnecessary worry.

little shortness of breath on exertion. Frequently the complaint is only discovered by accident when, for example, a patient is undergoing a routine examination for life insurance or recruitment in the armed forces. Symptoms and signs appear if the muscle of the left auricle can no longer work up to the higher standard that is required-in other words compensation begins to fail. rn this event the lungs are liable to become congested because the left auricle can no longer receive its already increased quota of blood. Hence shortness of breath increases and the patient may cough up blood. Extra strain is thrown on to the right side of the heart which in turn compensates in much the same manner as has been described in the case of mitral disease, Ultimately, however, the patient may develop the symptoms and signs of chronic cardiac failure (the article dated 20.10.57). Fortunately there is now an operation which can be performed on the mitral valve when it has become stenosed.

Mitral stenosis The word 'stenosis' means narrowing of an opening, hence it is not difficult to understand this variety of valvular disease. The mitral valve no longer opens fully, hence the opening froni the left auricle to the left ventricle is narrowed and there is therefore a tendency for the auricle to pump an inadequate quantity of blood into the ventricle. Compensation, however, quickly occurs and the walls of the auricle become hypertrophied and more powerful than in a normal heart. By this method the difficulty is overcome. The fact that the auricles themselves beat or contract is not always appreciated by the student of elementary medicine; the beat which forces blood into the ventricles occurs immediately before these chambers themselves contract. Forcing blood through a stenosed opening naturally produces a murmur which can be heard by the doctor and the fact that this murmur occurs just before the beat of the ventricle enables him to make his diagnosis. Often, however, mitral stenosis and incompetence are combined conditions. The symptoms and signs of mitral stenosis are often negligible for many years, except perhaps for a

Aortic disease The aortic valve is liable to incompetence, stenosis or a combination of the two. It is not nearly so cornmon as disease of the mitral valve, but is due to similar causes such as certain varieties of rheuma-

tism when it develops in later life it is often due to hardening of th~ arteries or the complaint known as arteriosclerosis. In aortic incompetence, blood tends to flow back into the left ventricle after its beat. The aorta and hence all the arteries of the body thus tend to receive a deficient amount of blood while the left ventricle tends to become overfilled. Compensation, however, readily takes place; the left ventricle becorrring larger and stronger than normal, thus correcting the deficiencies above described. So long as this compensation remains effective there may be 110 symptoms. Should it show a tendency to fail, however, the characteristics are similar to, but not identical with, those of chronic cardiac failure. In aortic stenosis, the ventricle has difficulty in pumping blood into the aorta because the aortic aperture is narrowed. Tne ventricle compensates for this by becoming considerably hypertrophied. Symptoms and signs are similar to those of mitral incompetence; they are latent so long as compensation is well maintained. If this, however, tends to fail, faintnes s, giddiness, attacks of pain over the heart, shortness of breath even amounting to attacks like asthma are some of the characteristics that may occur.

IYAarPoJ6u/(ItOtI}?NO.3 on FIRST AID What is meant by a sterilised dressing? 2. How would you make a cold compress? 3. What could be used as an emergency dressing ? 4. How would you make a hot compress ? 5. What are the uses of slings? 6. How many kinds of slings are there ? 7. How may slings be improvised? 8. When is the St. John sling used? 1.

Answers on page 16.

FJRST AID & NURSJNG, NOVEMBER/DECEMBER 1957

FIRST ATD & NURSING, NOVEMBER/DECEMBER 1957

TWO NEW RESUSCITATORS Description of two portable mechanical resuscitators now available in this country p~ysiological

Yearly in his V ERstudies the first alder learns

that life is maintained by the perfect co-ordination of the three great systems, the vascular, the nervous and the respiratory, and that the failure to function of anyone of these must necessarily be quickly followed by the failure of the remaining two, resulting in the death of the individual. He is, therefore, taught to take temporary measures to prevent the total failure of any of these systems whose function may be interfered with as a result of accident or disease until the arrival of a doctor or more scientific equipment. He learns to prevent further haemorrhage by the application of digital or instrumental compression. He knows what measures to take to reduce certain nervous conditions, and he can apply artificial respiration to maintain or restore breathing in the case of asphyxia. Often, however, in the last-named case, more drastic measures are required to continue his valuable initial work, and these are supplied by mechanical resuscitators which have been devised as a result of an intensive study of the mechanism of the natural breathing apparatus in our bodies. These have been improved from time to time, and British Oxygen Gases Ltd., have now produced the Stephenson 'Minuteman' resuscitator which appears to have overcome the defects found in many of the former resuscitators. An effective resuscitator must have a double action. It must ventilate the lungs in a regular and efficient way so that sufficient oxygen is carried to the blood and the waste gases removed. It must support the failing circulation by assisti ng the return of blood to the hea rt. Elaborate double action installations are to be found in the more j mportant hospitals, but these great electrical machines are of little value to the electrocuted engineer lying on the factory floor or to the miner overcome by firedamp one mile from the surface.

Until recently, the portable resuscitating machines available were only single action. Their weaknesses have been the target of research for the past few years, and an effective portable machine has now been developed after lengthy experiments. The machine is known as the , Minuteman' and was named after the traditional soldier-farmer of American folklore who was always at the ready to protect his countrymen. This machine is light in weight-it weighs only 28 lbs.-and it can be carried quickly to the scene of an accident. It is robust, simple in operation, and requires less skill and energy than other modern methods of resuscitation. It can be used in confined spaces such as pit shafts, ambulances, or under debris. It can also be used for patients with fractured ribs, and this is of particular value since manual resiscitation is dangerous in cases of this nature. The resuscitator is expected to prove of real value in cases of gas

and drug poisoning, drowning, electrical shock, stroke, heart failure, etc., and its designers are confident that it will soon build as impressive a record of lives saved in this country as it has in America. At the invitation of Messrs. British Oxygen Gases Ltd., we recently visited their factory (medical division) at Edmonton, where we were received by Mr. W. A. Pierson, the technical superintendent. Seated in his office, Mr. Pierson explained to us the principle of the device before demonstrating the machine itself. He then conducted us out to the factory, where we were introduced to Mr. G. O'Connor, a designer in charge of this department of the factory, and who would be demonstrating it to us. Upon the case, which measures 2 ft. by 9 in. by 7 in., and weighs only 26 lbs., being opened we saw a 72 gallon oxygen cylinder, which appeared to occupy one half of the interior space. Attached to the head of the cylinder was a fitting consisting of a cross-

A teature 01 the Minuteman resuscitator is that two patients can be treated at the same time. Two midget face masks can work from the same source.

piece, on one ann of which was the pressure reducing regulator, fitted with a gauge for measuring the contents of the cylinder, a hinged yoke to take another cylinder of similar capacity if required or, alternatively, a large cylinder of 48 c.f. capacity or over, used for oxygen therapy, or, in case of emergency, an industrial oxygen cylinder. From the pressure regulator a flexible tube led to a manifold carrying three Schrader type self-sealing gas outlets. Into one of these is fitted a female coupling on the end of the flexible tube attached to the Midget resuscitator which is held in the hand. A face mask can be quickly attached to this by means of a pushon fitting-there. are two sizes of face mask, one for an adult and one for a child-and the whole equipment is ready for immediate use. Either oxygen or a mixture of oxygen and nitrogen can be administered, but if the latter, then the mixture can be varied by simply operating a rotatable ring fitted round the Midget. Flow Control Device As soon as the valve is opened the cycle commences by producing inflation, but when the pressure in the lungs has reached a certain designed maximum, a delicate piece of mechanism causes the flow to be reversed, thus producing deflation of the lungs, the flow being again reversed when the deflation has reached a certain designed point. Thus inspiration and expiration can be restored and maintained by this most ingenious device. By operating the adjustable knob with which the Midget is fitted, alternate positive and negative pressures, with nominal values of 14 mm. Hg. and 9 mm. Hg. for adults and +9 mm. Hg. and -5 mm. Hg. for infants can be produced. Should a steady inflow be suddenly required instead of the cycle action, this can be immediately obtained by pressing a button in the top cover of the Midget. The unit then becomes an inhalater. In addition to the Midget resuscitator described above, there is still another attachment by means of which it can be converted into an aspirator to clear the mouth and airway of obstructions such as blood or mucus. This consists of a metal cap, a transparent nylon screw-in jar, an operating trigger and a catheter, and is connected to

one of the outlets from the manifold by means of a flexible tube terminating in a female coupling. Oxygen can also, if required, be administered through the catheter. Perhaps one of its most valuable assets lies in the fact that every tiny individual part of the equipment bears a distinguishing number, and can be replaced separately. A Heavier Machine . After thanking Mr. O'Connor for having been so patient in answering our many questions, we were introduced to Mr. K. Spinks, who proceeded to describe and demonstrate the' Pneumotron ' resuscitator. This is in the form of a rectangular box, 21 in. by lOin. by 10 in., but is less portable than the 'Minuteman,' weighing about 40 lbs., and is electrically operated. It has, however, many points to recommend it. The oxygen is supplied from a cylinder, but can be carried by means of a pipeline. When the demand circuit is used, an attempt at inspiration by the patient, with the mask fitted on the face, creates a slight negative pressure which deflects a sensitive metal diaphragm in the trigger unit. An interrupter, linked to the diaphragm, is lifted, thus allowing a beam of light to shine on the sensitive element

of a germanium photo-electric cell, causing a current change. This , triggers' the electronic circuit. An electro-magnetic gas delivery valve is then opened allowing gas to flow to the face mask for the inspiratory period. Loss of gas to the atmosphere is prevented by an electromagnetic expiratory valve which closes simultaneously with the delivery valve opening. At the end of the inspiratory period the gas flow ceases and the expiratory valve opens allowing the patient to exhaust freely to the atmosphere. The machine then waits for the next attempt at inspiration, thus allowing the patient complete freedom to exhale and pause before again breathing in. The operator has complete control of the action of the machine. He can adjust the cycle of inflation/ deflation to the efforts being made by the patient, and also the flow and volume of oxygen being delivered at any given moment. The 'Pneumotron' is a most useful machine, being equally effective in resuscitating a premature baby and producing and maintaining respiration which has failed or is failing in such cases as poliomyelitis, tetanus, head injury, etc. Moreover, it is capable of being used continuously for long periods.

New Ambulance for Esso Refinery

A NEW ambulance which is fitted with

the latest resuSCitation equipment has been put into service by the Esso Petroleum Co. Ltd., at their refinery in Fawley, Hants., which is the largest in Europe. The ambulance has been designed by the firm's medical department with the co-operation of British Oxygen Gases Ltd. The ambulance was built on a Morris chassis by Wadham Brothers Ltd., C?f Waterlooville, near Portsmouth. It IS fitted with an oxygen pipeline which is served by two 120 cu. ft. cylinders housed in the driving cab. The pipeline has three outlet points, one in the cab and the remainder in the patient's compartment. Two-way radio communication enables the ambulance to be directed to any part of the vast site should an emergency arise. A portable Minuteman resuscitator which enables patients to be revived at the ~cene of any accident is provided, and two Midget resuscitators which can be connected to the oxygen pipeline are installed. A 75. ft. extension lead is provided so that a patient can receive treatment some distance from the ambulance and also while he is being carried back to the vehicle. The Midget resuscitators can be used with the ordinary Polymask assembly to

administer oxygen to a patient who is still breathing. The resuscitators are expected to prove of great value in dealing with cases of gassing, severe burns, chemical hazards and electrocution. The ambulance has [I portable guide light to provide illumination at a distance of 60 ft. from the vehicle, and it has also been equipped with Neil Robertson. bamboo stretchers for the easy lowenng of patients. A plasma hook is b~ilt into the ceiling to enable the carrymg out of blood transfusions, etc. Mains heating under the floor ensures a constant warm atmosphere inside the vehicle and enables blankets to be kept well aired. . A siren and flashing light give warmng in the more noisy areas of the refinery. A 50 ft. lifeline rope for the ~aising. and lowering of injured personn.ei IS prOVIded, together with a tow rope which can be used if the vehicle has to be released from a muddy area. Lockers occupy all other available space. The ambulance can accommodate a maximum of four patients lying down, or alternatively it can ac~oI?moda!e. one lying down and six in a sitting posltlOn,

FIRST AID & NURS1NG, NOVEMBER/DECEMBER 1957

FIRST AID & NU R SING, N OVEMBER /D ECEMBER 1957

kept on our shelves for many years. Some, we noted, had recently gone into new editions. A number of diagnostic reagents for simplified routine urine testing were being demonstrated by Messrs. Ames, although- perhaps we are oldfashioned-we find it difficult to depart from the well-established methods we have practised for many years. On the stage in the Exhibition Hall

The London Nursing Exhibition WE are living in an age of progress, and this applies no less to the nursing profession than to any other department of activity. In order to enable nurses to keep abreast of the times the London Nursing Exhibi tion and Professional Nurses' and Midwives' Conference has been held annually under the auspices of our contemporary, the Nursing Mirror. Its object is to bring before professional nurses a comprehensive display of new and established products by leading trade houses in the drug, pharmaceutical, hospital equipment and allied trades, and to provide technical information for visiting nurses and midwives, for which a full programme of lectures and films is arranged. Although primarily for the profession, it does not appear to be generally known that our auxiliary nurses can obtain passes to the Conference and Exhibition by applying to their own organisations, but it is not open to the general public. This is its 42nd year, and it was again held at the Seymour Hall, London, W.l, and lasted for five days. The Exhibition was opened on the first day by the Patron, Her Royal Highness, the Duchess of Kent e.r., G.e.V.O., G.B.E., who showed a keen interest in the wide range of exhibits as she toured the halls afterwards. In the Conference Hall three interesting lectures were delivered during the day. John Peel, Esq., M.A., D.M., F.R.C.S., F.R.e.O.G., described 'The Life and Work of Sir William Gilliatt' the .late President, who passed away du.rm~ the past year. By a curious cOlllcldence the Council had decided before last year's Conference, and before the tragic death of Sir William to discontinue the Blackham Memori~l Lecture. Later it was thought fittmg that they should establish a memorial lecture to commemorate the life and work of their late President, and to make this the first lecture of this year's Conference. The chair was occupied by Professor Robert Platt, M.D., President of the Royal College of Physicians, a Deputy Patron. The second

lecture of the day dealt with 'Intestinal Obstruction,' by Richard H. Franklin, Esq., F.R.e.S ., when the chairman was Sir Cecil Wakeley, Bt., K.B.E., C.B., F.R.C.S., Honorary Convenor of the Conference. Harold Dodd, Esq., Ch.M., F.R .e.S. delivered the third lecture of the day, which was on ( Varicose Veins and Ulcers,' when the chairman was Eric Crook, Esq., M.Ch., F.R.C.P. Lectures during the remainder of the week covered a diversity of subjects, including 'Gallstones,' (Treatment of Coronary Artery Disease,' , Poliomyelitis,' 'Respiratory Diseases,' (Surgical Relief of Pain,' 'Radiotherapy in Cancer,' , Bedsores' and 'Peptic Ulcer.' The fourth day, Thursday, was Midwives' Day, when the lectures and films were devoted to obstetrics and gynaecology. Handicrafts Competition On the last day, Friday, the Exhibition was visited by the Lady Mayoress of London, Lady Welch, who presented the challenge cup and gold thimble to winners of the Nursing Mirror handicrafts competition. A tour of the Exhibition was an education in itself, but it would be impossible to mention a fraction of what was to be learned there. However, there were some exhibits which arrested our attention and which deserve special mention. At the stand of Messrs. Oxygenaire Ltd., we saw a portable incubator designed for use in flying squad ambulances and in aircraft. Permitting the transportation of a premature infant over long distances in an oxygenated atmosphere, this equipment is almost equal in efficiency to an up-to-date premature baby ward in a maternity hospHal. At the same stand we saw the Oxygenaire iceless oxygen tent embodying a completely sealed refrigerator unit giving improved control of oxygen concentration humidity and temperature, elimin~ ating all noise which until now has been unavoidable when reloading a non-electrical tent with blocks of ice. Another new type of incubator for premature babies, also produced by

this firm, was used, we learned, for three sets of quads born in Great Britain this year, and appeared to be the last word in oxygen therapy for premature infants. An important feature of this model was the inclusion of safety devices' such as warning bells, flashing lights, etc., thus minimising all risks of breakdown of electrical circuits or mechanism, or to increased temperature that might prove harmful to the infant. For routine ward treatment Messrs. S. H. Camp & Co. Ltd., were showing a scale model of an entirely new type of treatment bed for use in hospitals and clinics by nurses and physiotherapists. Baby Ambulance For those engaged m ambulance transport there was an extremely light piece of equipment, the Oxycot, another production by Messrs. Oxygenaire Ltd., for the manual or vehicle transportation of a sick child in a heated or cooled oxygenated atmosphere. We were informed that this had been used recently to carry a (blue baby' safely from its home in the Rhondda Valley to Great Ormond Street Children's Hospital, a distance of 180 miles. Educational and Scientific Plastics Ltd., were displaying many excellent manikins, anatomical and other models, both full -size and miniature, which should prove of great value to lecturers, demonstrators and others in the class room. At the next stand representatives of the National Hospital Service Reserve were giving information and enrolling new members. Messrs. Richards Son and Allwin Ltd., were displaying a large variety of invalid, carrying, folding and hospital chairs, one specially designed for negotiating stairs and narrow corridors. Of bandages and dressings, a long range of Elastoplast products were to be seen on the stand of Messrs. Smith & Nephew Ltd., whilst another firm showed us a new tubular bandage. Hundreds of technical works were to be found on the stands of Messrs. H. K . Lewis, Faber and Faber and Bailliere, Tindall & Cox., whose' Aid' series is so well known, and which we have

we found the Nursing Mirror at home to visitors, and members of the staff were present to welcome and give advice to nurses and midwives visiting the Exhibition. Around the stage was a most interesting display of photographs of 'Distinguished Nurses,' past and present. In the small hall we gained a glimpse of the private lives of nurses, for here we discovered a fine display of handiwork by nurses and

7 midwives~hand sewing, embroidery, knitting, crochet and other arts -which included the prize winning and commended entries in the Nursing Mirror Annual Handicrafts Competition. Both the Exhibition and the guide catalogue reflect the greatest credit upon the organisers, but may we offer one little suggestion? A classified index would be of great assistance to visitors.

Competitions ASK any st. John-trained first-aider his or

her greatest ambition in life and he or she will reply without hesitation, 'To get into the finals for the Grand Prior's Trophies.' This year 21 teams, men and women, after winning the national final competitions in their respective organisations, competed for these coveted trophies at the Porchester Halls, Bayswater. As is always expected at this competition, the tests, both team and dual practical, were stiff but interesting.

J II

Men's Team Test, judged by F. H. Taylor, Esq., O.B.E., M.D., of London: The team has been invited to witness a rehearsal of the famous balcony scene from Shakespeare's 'Romeo and Juliet.' They are sitting in the theatre when part of the scenery collapses, trapping Romeo. The team is expected to offer assistance. Injuries: Romeo-Simple fracture of pelvis, right side, simple fractures of 7th and 8th ribs, right side, lacerations of back of left hand with slight haemorrhage, shock. Juliet: Slight abrasions of right knee and right elbow, frightened. Men's Dual Tests, judged by Ian Mackenzie, Esq., M.B., B.S., of Derby: Nos. 1 and 4, visiting a friend who lives alone, witness an accident. They see their friend, whilst making tea, spill the boiling water and fall to the ground, knocking his elbow against the gas stove. Injuries: Scalds on both legs, simple fracture of right humerus, mid-shaft, shock. Nos. 2 and 3 are also calling on a friend, but find him lying on the floor in front of the gas stove. There is a smell of gas. Attempted suicide might be suspected. Tnjuries: Breathing is failing, gunshot wounds (entry and exit). The haemorrhage is slight. Women's Team Test, judged by W. L. M. Bigby, Esq., M.B.E., M.B., of Southampton, and R. Renwick, Esq., M.R.C.S. L.R.C.P., of Watford: Travelling by car, the team finds a crashed motor cyclist with his pillion passenger lying in the road, havi ng apparently skidded on a bend. Injuries: Cyclist-wound on medial side of lower half of right thigh with severe haemorrhage, simple fracture of right leg , shock. Passenger: Concussion (unconsciolls), fracture of base (classic signs).

The Grand Prior's Trophies Women's Dual Tests. judged by D. D. Towle, Esq., B.A. , M.B., B.Ch., of London: Nos. 1 and 4 are called by a woman to attend her husband who has fallen to the floor whilst nailing a picture. Injuries: Bruise on forehead, fracture of tip of ulna, severe burns on right forearm (contact witb wife's iron). Nos. 2 and 3 find a cyclist lying on the road, having skidded and fallen on left elbow. Injuries: Dislocation of left elbow joint, deep wound of left palm. After an interval for tea the chair was occupied by Horace F. Parshall, Esq., T.D., M.A. (Oxon.), Director-General of the St. John Ambulance Association, and he was supported by the Lord Wakehurst, K.C.M.G., Lord Prior of the Order of St. John; Maior James Collins, J.P., and Mrs. Collins, Mayor and Mayoress of Paddington; the Countess Mountbatten of Burma, C.I., G.B.E. , D.C.V.O., Dame Grand Cross, Superintendent-in-Chief of the St. John Ambulance Brigade; C. T. Evans, Esq., C.M.G., Secretary-General of the Order of St. John; Sir Ernest Burdon, K.C.I.E., e.S.L., LL.D., Receiver-General of the Order of St. John; Major-General J. M. Kirkman, C.B., C.B.E., Commissioner-in-Chief of the St. John AmbuJance Brigade; Major A . C. White Knox, O.B.E., M.e., M .B., Ch.B., Principal Medical Officer, S.J.A.A.; Lieut-Col. E. C. Croft, Deputy Director-General, S.J.A.A.; Major-General W. E. Tyndall, C.B.E., M.e., Deputy Director-General, S.J.A .A.; the Assistant Director-General,

S.JA.A.; Guy W. J. Bousfield, Esq., M.D., B.S. , Deputy Pri.ncipal Medical Officer, S.J.A.A., and the Judges. Amongst others present we noted Mrs. B. Grosvenor, C.B.E. , Deputy Superintendent-in-Chief, S.J.A.B., the Hon. Mrs. Leslie Gamage, County Superintendent (N.), S.J.A .B., Berkshire and Capt. E . Hale, R.N. (retd.), Chief Secretary, the Royal Life Saving Society. Mr. Parshall opened by expressing bis pleasure in being able once again to preside at these important finals, but he was particularly happy to welcome the Mayor and Mayoress of Paddington, who had once again been willing to spare the time from a very busy life to be present with them. Further, he felt sure that they were all pleased to see the Lord Wakehurst, Lord Prior of the Order of St. John, who had shown his interest by rising from a bed of sickness and coming over from Northern Ireland, of which he was, as they all knew, Governor. It was his pleasant duty to thank all those who had helped to make the event a success, and he only wished that he could name them all individually. First of all, there were nearly 70 stewards, as well as the time-keepers, the St. John-trained 'fakers' and 'patients' and many others too numerous to mention. He would like to thank, once again, the Associated British Picture Corporation Ltd., whose representative was on the platform with him, whose invaluable help on these occasions they so much appreciated. He mentioned specially the judges, those busy men and women, so highly qualified, who were always so ready to give of their time and knowledge in the promotion of this grand

(Left) The winning men's team with their Grand Prior's Trophy. L. to R .: E. Han, D. R~dy, A. Brian, G. Jackson (Capt.), and I. Perry all from Whitwick Colliery, l:eicester .. .(Rlght) Presentation of the Trophy to the Ladies Team by Lord Wakehurst to MISS H. WillIamson, Captain of the H.Q. No. l}Jranch, P.O.A.C.,.G.P.O. Ambulance Centre T~~m.

8 cause, for, he reminded his hearers, they not only came to judge our competitions, but they also train our students in first aid and nursing. They could never be thanked sufficiently. Lastly, the competitors without whom the competitions would not be possible. Mr. Parshall went on to say how pleased they were to see the representatives of the various organisations and national bodies from which the teams were drawn, and he reminded them of the great value attaching to the encouragement which the teams received from them. It was most inspiring to trace the growth of the movement from its inception to what they had seen that day, but he asked the competitors to realise that this was not their ultimate goal, but simply a means to an end. He asked them to remember that the competitions helped them to make themselves efficient that tbey might render that service to mankind. The chairman again referred to the valuable work of the judges, not only in judging the competitions but for their criticisms afterwards, for if the competitors would listen to the advice they were given by the judges they would appreciate their mistakes and would never repeat them. He asked Dr. Taylor to make his comments. Dr. Taylor opened in a humorous vein stating that after all the trouble the Asso~ ciated British Picture Corporation had taken to build t~e 'Romeo and Juliet' scene, it was no reflectJOn upon them that the balcony collapsed! Becoming seriolls, he stated that both he and Dr. Mackenzie were agreed that the standard had been high. Perhaps some had thought that the judges had been severe, but it was because they expected such a high standard at the' Grand Prior' that they were .severe in their marking. However, he beheved that the competitors would appreci~t~ .this point. Regarding the tests, he cntlclsed the examination of the patient in many cases as being far from thorough. He also warned them that there was far too much talking to the judge. This was entirely unnecessary, for the Judge could see what they were doing. When, ~owever, it is really necessary to ask a questJOn they must pay attention to the judge's reply, and he gave as an example one competitor who, having been told that the bre~thing was' shallow,' immediately asked Its character. He only saw one team fasten the sling with two safety pins according to the teaching of the text book. He concluded with a few encouraging words, especially to the new teams he had seen that day. Dr. Bigby, speaking on behalf of his colleagues, Drs. Renwick and Towle state~ that they, l~ke Dr. Taylor, had bee~ very Impressed wIth the high standard of work. Referring to the lady pillion passenger, he created a Jaugh by saying, .That was what she got for accepting a lIft from a strange man. Let that be a warning.' He did hope, however, that they w(;>uld all appreciate the importance of wearmg a crash helmet. He emphasised that be~ause a patient says that he cannot move hIS el~o~, that does not necessarily mea~ that It IS fixed, indicating a dislocatIOn. .Burns, he said, are aseptic for some mlllu!es after the contact, but your fingers are, .If not actually dirty, by no means surgIcally clean, and could introduc(:

FTRST AID & NURSLNG, NOVEMBERIDECEMBER 1957 sepsis into the wound. Every care must be taken to keep a burn or scald aseptic. He commended the ingenuity of the team who used grass from the field for padding. , We are very pleased,' he concluded, ' with the general standard of work, and also with the co-operation of the patients.' In announcing the results, Col. Croft explained that in the case of ties the teams which had obtained the higher marks for the dual tests had been placed first. RESULTS MEN 1. Whitwick Colliery, S.J.A.B. ... 329 (winning the Grand Prior's Championship Trophy for Men) 2. B.T.C. (Railways and Docks) Exmouth Junction M.P. , No.1 320 3. ExeterCityPolice ... } . 4. Manchester Fire Brigade tied 3 I 9 5. Fulham British Ele:::tricity Ambulance Centre 313 6. Eastern Gas Board .. . 312 7. G.P.O. Ambulance Centre, Inland Section, tied 300 Mount Pleasant .. . 8. B.T.C. Police, Dover .. . 9. National Road Passenger Transport Ambulance Association, Chiswick ... ... 279 10. R.R.E., Defford, Ministry of Supply Ambulance Centre 267 11. Great Mountain Colliery, Miners' National First Aid Competition . . . . .. 243 12. Nati~)J1al Dock Labour Board, Gnmsby ... ... .. . 239 13. United Kingdom Atomic Energy Authority, Harwell ... ... 229 WOMEN 1. G.P.O. Ambulance Centre, H.Q . No.1 Branch, P.O.A.C. . .. 342t (winning the Grand Prior's Chamoionship Trophy for Women) 2. North Western Gas Board ... 336~ 3. National Road Passenger Transport Ambulance Association Liverpool . .. ... . . : 328t 4. Swindon British Electri-I city Ambulance Centre . tied 322!5. Clapham Common, r < S.J.A.B.(N) ... . .. j 6. B.T.C. (Railways and Docks) Newton Abbot ... ... 320 7. St. Giles' Court, Ministry of Supply Ambulance Centre . . . 308 8. United Kingdom Atomic Energy Authority, Harwell ... ... 274 Commenting upon the results which had just been announ'..cd, Mr. Parshall reminded them that all the teams they had seen at work that day were to be con~ra~ulated upon having survived the preIImmary and regional competitions before they could compete in the finals. He was pleased to see so many new teams. I n ~ short address before presenting the trophIes, the Lord Prior said that he ~ould like to add his sincere congratulatIons to those which had already been expressed, for was this not the blue riband of the St. John Ambulance Year? He had also been asked by the Grand Prior the Duke of Gloucester, whom he had s~en a fev.: days ~efore, to convey to all the comp~tltors hIS (the Duke's) personal good Wishes, for he realises the importance of these competitions as ~ valuable contrjp\I-

tion to their efficiency. Lord Wakehurst then continued to comment upon what he had seen that day, saying that he bad been impressed by the tremendous enthusiasm displayed by all, both competitors and spectators. He wondered if the public realised how widespread the movement really is. Last year over 100,000 certificates had been awarded by the Association in Great Britain and Ireland, and over 200,000 more had gone to overseas candidates. Surely these figures were formidable. He reminded his hearers that behind what they had witnessed that day there were the hundreds of preliminary competitions in the various organisations an~ official !:,<?di~s-police, railways, mines, vaIlOUS mlTIlstnes, gas and electricity undertakings, fire brigades, general post office, etc.-and involving vast numbers of competitors. They were most grateful to the heads and administrative staffs of these bodies for the encouragement they were giving the movement. We are he said, on the verge of big developments in firs~ aid. If we cannot entirely prevent aCCIdents, then we can, at least instruct people in what to do when tbey do ~ccur. He felt that they could safely continue to leave this in the safe hands of Mr. Parshall and his colleague, Major White Knox. . I can assure you,' he concluded, , that the Order does appreciate the work of the Association.' The winning teams were then called one by one, and the Lord Prior presented the trophies. As each competitor passed the Countess Mountbatten on their way from the platform, they were greeted with a sweet smile and a few words of encouragement-entirely off the record. Commemoration plaques were presented to the leaders of last year's winning teams. These were the Metropolitan Police L Division and Spalding Nursing DiVision, S.J.A.B.

For a change we publish a photograph of the runners up. In this case it was an outstanding achievement for the North Western Gas Board Liverpool Ladies First Aid Teamthey gained the highest place yet attained by a Gas Industry Team in this contest. (front row L. to R.) Misses V. Spackman (Capt.) C. Price, M. Anderson, Z. Parry.

FIRST AID & NURSING, NOVEMBER/DECEMBER 1957

Compl! titions-COI1 f il1/(ed Casualties Union Day

FIF!EEN years ago it occurred to a few Interested persons that, in order to train ambulance and nursing personnel thoroughly, it was necessary that students should be acquainted with the appearance and behaviour of the patients whom they may be called upon to treat. Today, instead of finding 'patients' with cards att~ched denoting their injuries, competItors are faced with 'patients' skilfully made up to represent injuries and trained to act the part. The technique of 'faking' and acting has now become a fine art, and the Casualties Union consists of expert nrst aiders who also have become specialists in both these departments, the Union itself being now regarded as one of the great teach ing organ isations. Li ke other teaching organisations, they hold an annual event, but instead of being a simple competition it has now developed into a combination of competitions, demonstrations and displays, and was held tbis year on the London University Sports Ground at Motspur Park through the courtesy of the Collegiate Council. Perhaps we cannot do better than invite our readers to accompany us in imagination on a tour of the grounds and at the same time keep an eye on the programme of events for the day. Arriving at the entrance, where we were greeted by Miss Elston, the Union's energetic assistant secretary, and Mrs. Helen Nicholson, the editor of the Casualties Union Journal, our attention was directed to a strange-looking structure on our left. It had been erected for a new type of test, but as this competition had not yet commenced we would return to it later. I n an enclosure on our left we found Mr. H. C. Excell, an expert from Brighton, in charge of a Study Circle, lecturing and demonstrating, with the assistance of Mr. J. R . Holland, the art of making up , or, as it is more often called, , faking.' At the R .O.S.P.A. (R.oyal Society for the Prevention of Accidents) stand we lingered to watch one of the many 'incidents' staged by the actors and actresses to illustrate the cause of many accidents, and it was surprising to learn how many occur in the home, a large percentage of which are the result of carelessness or thoughtlessness, and are preventable. Miss Barbara Naish and Mrs . Hoskin were presiding at this stand. The next stand was the J nformation Bureau of tbe National Hospital Service Reserve, presided over by Dr. M. G. Allen, of Kingston Hospital, and it was gratifying to learn, when we re-visited this stand later in the day , that a large number of recruits had signed on to serve in tbis ,aluable service. It is open to trained members of the St. John Ambulance Brigade and the British Red Cross Society. Recruits are still urgently required, and if YOU have not yet considered the matter, make 'enquiries at your local S.J.A.B. or B.R.C.S. headquarters, or from the matron of your local hospital. Jf you are untrained, then either of these two organisations will train YOli.

Have you ever seen novices attempting to carry .a loaded stretcher? It is only by watchIng such an attempt that you can fully realise that this is a job for trained personnel. Our next call was an enclosure in which a competition in stretcher-bearing fo~ novices was in progress. Although thiS created a great deal of amusement it was also instructive, even to the trai~ed man or woman. On the stretcher was a vessel filled to the brim with a coloured fluid and standing in a tray, so that the tiniest drop spilled could be discerned. The competitors had to carry the stretcher to a fixed point and back again, negotiating en roule a fence and crossing a 'live' wire without spilling any of the liquid. Even trained personnel found this a difficult task. Tn another enclosure were a number of occ1Jpied beds, and Mr. A. J. Ferris, of the Newbury Branch, was illustrating, with the assistance of 'patients' and St. John and Red Cross nurses, various nursing procedures, including post-operative care and after treatment. One 'patient' was giving a most realistic demonstration of CheyneStokes respiration. Drs. 1.. D. Macdonald and Ayton Ormiston were in charge of a stand marked ' Diagnosis for Spectators.' How easy it is to criticise memoers of the teams whilst watching competitions in progress, but would you do any better yourself? At this stand members of the public, trained or untrained, were invited to test their skill in diagnosing a number of casualties which had been specially prepared, and we have reason to believe that many valuable lessons were learned at this stand. The promoters suggest a monthly exercise on these lines at your own detachment or division. Officers of the Institute of Civil Defence were 'at home' at the next stand to meet and welcome visitors, both members and non-members, and to explain tbe objects of the Institute, which is an independent technical association of men and women for the study of civil defence problems and the development of operational methods and training in both peace and war. Another competition for spectators, blindfold bandaging, created a great deal of amusement, but it was amazing to note how accurately many of the competitors applied the bandages, although it was obvious that they had practised beforehand. We do, however, recommend this as an exercise to be carried out in the classroom. At 10.30 a.m. we retraced our steps to examine more closely the strange structure which had attracted our attention upon our arrival. It should be explained here that industrial concerns and other bodies have long been studying the problem of the rescue of an unconscious man (e.g. concussion) from a manhole 8 ft. deep of standard pattern. For the purpose of assisting this study the Casualties Union had arranged a competition for groups of members of any firm or organisation in

order to discover, if possible, the best means to adopt in such a situation. For the purpose a tubular structure of concrete, 8 ft. high, representing a standard manhole, with glass panels in the sides for observation by both judges and spectators, had been erected by Messrs. Mono Concrete Co. Ltd., and the 'patient' had been specially. trained to act the part, and to report hiS own observations to the judges afterwards. The judges were E. A. Drew, Es~., B.Sc., A.M..LC.E., Chief Engineer, Middle Lee Regional Drainage Scheme; J. ~ckroyd, Esq., B.Sc., A.M.I.C.E., Englne.er and Surveyor, Swindon Borough Councll; G. S. Hughes, Esq., and Dr. T. T. Baird, of Cardiff. The competition was produced by J. Boyd , Esq. It is believed that many valuable l~ssons have been l~a!ned as a result of this unique competitIOn. At 2 p.m. the vast crowds gravitated to the arena, where the main first aid competition was to be held, in which four members of each team took part whilst the remaining two were competing elsewhere in the diagnosis tests. The judges for the first aid test were Drs. J. H. Chambers, of London; M. Cohen, of Hamp~tead; Major R. H. Freeman, R.A .M.C. (T.A.); A . Jarvis, of Brighton ; R. Mathews, of Crawley; R. St. J. Buxton, of Carshalton. J. Scriven, of Farnham; W. Verner, of Slough; Lancelot Wills, of Wembley; Messrs. C. Blake, of Brixton; G. Bugden, of Heston; E. L. K. Dunn, of South Harrow; S. W. Harden , of London; J. W. Limb, of Lewes ; H. Marriott, of Enfield; R. McNamara, of Brighton; E. O. Proctor, of London; W. A . Sheen, of Islington and S. V. Thompson, of Potters Bar. It should be explained that this large number of judges were necessary in view of the fact that there were four sets, four competitions being held simultaneously. The diagnosis tests were judged by Drs. J. S. Binning, of Harpenden ; R. G. BinnsYoung, of Lewes; 1. D. Innes, of Hull; Miss N. G. Austin, of Barnes; E. A. Harris, of Southend; L. Stephens, of Slough and G. Waller, of Wimbledon . The first aid test was a complicated one, involving the following story: Routine athletic instruction and training are in progress at Motspur Park Athletic Stadium. Unfortunately an accident has occurred at a practice flight of the high hurdles. A random throw from a javelin near the track has thrown a coach forward, and he is seen to be lying prostrate over a fallen hurdle. He has a wound in his back and is temporarily winded. He has also a fractured right clavicle, a grazed right thumb and blood is pouring from one nostril. A young woman, having made a good clearance of her hurdle in lane 1, has landed with her right foot on an upright of the fallen hurdle and has grazed her hands in the fall in addition to having fractured her right fibula which she is seen to be inspecting in a sitting position on the track. A young man, who has not fully re-

10 covered from a recent sharp attack of Asian 'flu is seen to be lying on the ground near the hurdles. Although he managed to get off to a good start he had a momentary blackout and veered slightly out of his lane aod has fallen 00 approaching the line of hurdles with a broken hamstring muscle in his left thigh. It is also noticed that he bas a dry, tickling cough from a deep-seated lung pain due to his imperfect state of fitness, and has grazed his hands, chin and nose. Whilst the judges were marking their sheets the interval was taken advantage of to seek refreshments, which could be obtained at the Regional Food Flying Squad canteen, through the courtesy of the Ministry of Food, and which was staffed by members of the W.V.S. At the presentation ceremony, which took place from the grandstand, the chair was occupied by Mr. Harry Davies, Chairman of the Committee. After extending a welcome to the guests of honour, Brigadier Dr. Glyn Hughes, CB.E., D.S.O., M.C., Q.H.P., and Mrs. Glyn Hughes, and to the vast number of spectators who filled the audience, he asked Dr. Wills, on behalf of all the first aid judges, to make a few comments on the main competition test. After briefly reminding his hearers of the principal points in the story, Dr. Wills stated that he and his colleagues were agreed that in nearly all cases the examination of the 'patients' had not been as thorough as might have been expected. Moreover, in the initial 'rush' of the competitors on the 'patients', they were unable to assess fully the situation. He emphasised that clothing had not been removed when it should have been, and in those cases in which it had been removed it had been done with insufficient care. They had seen bandages applied over thick pullovers which reduced the effectiveness of the bandages. In many cases the treatment for shock had been entirely omitted due, once again, to the lack of a full appreciation of the situation. However, although they had found it necessary to offer criticisms of certain procedures on the whole this complicated test had been tackled very well. There followed a parade of the casualties which had been prepared for the diagnosis tests, with a running commentary by Dr. l. S. Binning, of Harpenden. They included: Boil on the neck (not diabetic). Laceration of scalp. Simple fracture of right patella (elderly man). Fisbbone in throat. Toadstool poisoning (child). Superficial burns of right band, due to exploslOn of box of matches in hand. Sprained lefl ankle. Punctured wound of right calf. Cramp in calf muscle of left leg. Ruptured calf muscle (plantaris muscle) of right leg. Dislocated right shoulder. Mild concussion. Friction burns of hands and chest. Blow on left cheek bone (malar). Shingles (Herpes simplex). Alcoholic coma. Responding to an invitation from the chairman, Mr. E. A. Drew one of the judges of the 'manhole' test,' offered some

FTRST ATD & comments. He commenced by saying how pleased he was that this test had been arranged, for he felt that it would lead (0 the solution of a problem which, unfortunately, arose not infrequently, especially amongst workmen employed by concerns such as his (the Middle Lee Regional Drainage Scheme). Two men are senl to clear a sewer. One either falls down-or it may even be a careless passerby-or meets with an accident in the course of his work. The test had not been made too difficult, but at the same time it represented very accurately what does take place. Of the many points to be considered are the narroYmess of the manhole itself and also the narrow entrance. There were, also, sometimes noxious gases to be encountered. Like Dr. Wills, he emphasised the importance of making a fuJI assessment of the situation. There was at present not enough knoy,TI of the problem involved. He had been impressed by the ingenuity of some of the teams, and the various methods used had proved very interesting. All methods so far however had shown some defects, an'd it wa~ obvious that there was, at present, no common answer to the problem. The perfect I?ethod must be simple and quick, but partIcular care had to be taken of the head, spine and armpits. Again, the steps had proved a source of danger, and some teams had found it difficult to devise a perfect method of distributing the weight of the body correctly. He congratulated the Casualties Union upon having staged so valuable a test, into which so much thought had obviously gone. Then came the gre(l ~ question: 'Who have won the various competitions?' The results were as follows:

FIRST AID CO:vfPETITION I. Staffordshire County Police ... 340 (winning the' l :.tlk' Trophy) 2. Southend-on-Sea Constabulary 327 3. Desford Colliery ... .. . 325 4. East Riding of Yorkshire Police 313 5. Edinburgh City Police ... 5. I.CI. Winnington Alkali 'A' . 5. City. of Manchester Fire r tied 298 Bngade ... ... \ 8. Hampshire and Isle of Wight Constabulary 'A' ... ... 291 9. Brighton Ambulance Section ... 278 10. St. Albans, Eastern Gas Board 276 II. Wembley Ambulance Section ... ..: 268 Civil Defence ... 12. Reading Borough Police 261 13. City of Sheffield Police... 251 14. Grimsby Borough Police 'A' ... 237 15. Cornwall County Constabulary 234 16. B.R.C.S., Bristol 5, 'A'... ... 231 17. B.R.CS., Corbridge... 220 18. S.l.A.B., Wimbledon and Merton ' J7... ... ... ... 215 19. British Railways, King's Lynn... 214 20. S.l.A.B., Brislington... ... 199 21. Exe ter Ci ty Police 196 22. R.O.F., Chorley 'A'... 187 23. S.l .A.B., M.O.S., Cbessington 165 24. See board. Mid-Sussex ... 110

DIAGNOSIS COMPETITION 1. East Riding of Yorkshire Police 216 (winning the 'Diagnosis' Trophy) 2. Exeter City Police } tied 189 2. B.R.C.S., Bristol/5 'A' ::: 4. B.R.C.S., Corbridge 186

URST G,

OVEMBER DECEMBER 1957

5. St. Albans, Eastern Gas Board 6. Southend-on-Sea Constabulary 7. S.l.A.B., Wimbledon and Merton 17 ... .. . 8. City of Sheffield Police .. . 9. r.c.r., Winnington Alkali 'A' 10. Desford Colliery ... , 10. Edinburgh City Police ... I tied 12. S~~~~~s~i~e Co~.~ty

FI R ST

185 183 182 181 180 179

... )

12. G.rl~lSby .Boroug.~ .polic~.. \

tied

178

14. Brigh~on Ambulance ) SectIOn . . . . .. , tied 14. Reading Borough Police ) 16. Hampshire and I~le of V'l ight Constabt:lary ... ... . .. 17. Cornwall County Constabulary 18. Seeboard, Mid-Sussex ... } tied 18. S.,J.A.B., M.O.S., Chessmgton... ... .. . 20. S.l.A.B., Brislington ... I . d 20. R.O.F., Chorley 'A' ... i tle 22. City of Manchester Fire Brigade 23. British Railways, King's Lynn ... 24. Wembley Ambulance Section Civil Defence ... .. . ..:

177 176

172

168 167 166 140

OVEMBER 'DECEMBER 1957

Turning to the President , Brigadier Dr. Glyn Hughes, the Chairman said how pleased they all were to see him and Mrs. Glyn Hughes there that day as their guests of honour. Although Dr. Glyn Hughes was such a busy man, he spared the time to take a real practical interest in the Casualties Union, and his help had always proved most valuable. Although he 10\'ed a round of golf as a relaxation (and he was a member of a club in which there were 0 ladies!) he seldom had the time to indulge in his favourite sport. 'We in the Casualties Union: said the chairman, 'ha e a great regard for him, and sincerely trust tbat hewill bewith us formanyyears to come.' The ovation v,hich followed \vas sufficient evidence of the confirmation of all with whom he had been associated. Rising to present the trophies, Dr. Glyn Hughes said, 'Today I am here in a different position. I am one of you- a guest.' He had seen many of the teams at work that day. and he was pleased to agree with \\hat many of the previeus speakers had said-

that the ~tandard of efficiency bad been excellent, but he hoped that they would go on to do even better. He had been pleased \yith all he had seen that day, but, like most of those there, he had been particularly interested in the 'manhole' test. The enthusiasm of both competitors and spectators was ample proof of the \\holehearted purpose behind the Casualties Union, and he thanked them for the gift which had been presented to him. E\'ery man and woman in the land should have a basic kno\\ledge of first aid, for we must be prepared. The Casualties Union \\as doing a fine job. he concluded before presenting the awards to the \\inner . Mr. E. C. Claxton, M.RE .. said tbat it would take a long time to thank the President sufficiently for all that he bad done for them . They were all most grateful to him and to Mrs. Glyn Hughes for consenting to e their guests of honour that day, and for pre enting the trophies. They were, indeed, fortunate in haying him for their President.

1r. Claxton said that there were 0 many he would like to thank for their as istance, but he could onlv mention a fraction of them. The doctors and judge \\ere the first that came to his mmd. for they had gi\'en of their time and skill in Ihi great cau e. The Collegiate Council of London Uni\'ersity had gra'ilted them the use of that magnificent sports ground. for which they were mo t grateful. The eyenr would ha\'e been lmpo ible without the co-operation of such bodies a the British Red Cross Society. the St. John Ambulance Brigade, the Institute of Civil Defence, the Boy Scouts' and the Girl Guides' Asociations, the R.A .M.C.. the Ministry of Food and the W.V.S.- to all these and many others they tendered their most sincere thanks. but by no means lea t. their hardworking Competition Secretary. Mi s A . F. M. Murphy. \\'ho had been re ' ponsible for the organisation of the e\·ent. and their Hon. General SecretarY, ;\1r. P. G. Sargeant. . We hope to ee 'you all again next year,' concluded Mr. Cla,ton.

National Police Lifesaving Championships Royal L~fe Saving Society

529 518 513 510 504 478 477 467 464 461 455 438 432 420 407 406 398 397 385 366 354 333 278

, MANHOLE' COMPETITION 1. Brislington S.J.A.B. ... ... (winning the ' Jarvis' Goblet) 2. John Dickinson Fire Brigade ... 3. RomfordCiviIDefence'B' ) tied 3. Hampshire 5, B.R.C.S .... [ 5. London Transport 'A' ... I tied 5. Oxford Civil Defence ... j 7. Seeboard, Hastings 8. D. Napier & Sons 'A' 9. R.O.F., Chorley '" 10. Thames Board Mills'B' 1 lied 10. Oxford c.c. ... i 12. Stafford Civil Defence ... 13. Romford Civil Defence 'A' 14. D. Napier & Sons 'B' ... 15. Thames Board Mills 'A' 16. Distillers' Company '" l tied 17. Ealing Civil Defence 17. Hawker Aircraft 'A' ... J 19. Lop-don Transport 'B'

URSr

139

COMBINED FIRST AlD A:\,D DIAGNOSIS 1. East Riding of Yorkshire Police (winning the' Buxton' Trophy) 2. Staffordshire County Police ... 3. GrimsbyBoroughPolice'A' ... 4. Southend-on-Sea Consta bu lary 5. Desford Colliery ... ... 6. I.e.!., Winnington Alkali 'A' ... ... 7. Edinburgh City Police... 8. Hampshire and Isle of Wight Constabulary ... .. . ... 9. City of Manchester Fire Brigade 10. St. Albans, Eastern Gas Board 11. Brighton Ambulance Section 12. Reading Borough Police 13. City of Sheffield Police ... 14. B.R.CS., Bristol 5, 'A' ... ... 15. Wembley Ambulance Section, Civil Defence ... ... ... 16. Cornwall County Constabulary 17. B.R.C.S., Corbridge ... ... 18. S.,T.A.R, Wimbledon and Merton/17 ... 19. Exeter City Police 20. S.J.A.B., Brislington... 21. R.O.F., Chorley 'A' ... 1 21. British Railways, King's tied Lynn ... ...1 23. S.l.A.B., M.O.S ., Chessington 24. Seeboard, Mid-Sussex ...

ID &

74 69 68 66 65 64 62 61 60 59 57 55 54 48 45

WHY ha\e we waited so many years before recognising that the Royal Life Saving Society is ' one of us .? Is not the work of this Society closely related to ambulance and nursing? Moreover, a further link between the Society and ourselves is to be seen in the fact that their President is Admiral of the Fleet, the Earl Mountbatten of Burma, wbose wife, the Countess, is so well known and loved throughout the ambulance and nursing world. Further, is not their Deputy President Sir Cecil Wakeley, another name to conjure with in the ambulance and nursing field? This bond between us must be established without delay, and we were very pleased to see their Chief Secretary, Capt. E. Hale, as a guest at the Grand Prior's Tropby finals. One of the principal events in the Society's year was the ational Police Life Saving Champion hip Competition, which was held this year at the Metropolitan Police Training School, Hendon, in which 11 teams from all parts of Great Britain and Northern Ireland competed for the championship Trophy. The form of the Trophy was certainly unique, consisting of a police baton in silver gilt and bearing the badge of a chief constable. The whole was mounted on an ebony plinth, with the badge of the Royal Life Saving Society in enamel. The Trophy is held by the winning police force for a period of one year. A certificate is presented with the Trophy, and each member of the winning team and the reserve member receives a silver plaque. The runners-up receive a bronze plaque. The competition opened on the word of command 'captains forward!' The captains of the respective teams then paraded and the roll was called. Each team was seen to consist of five members, one of whom acted as captain, and was not required to perform the tests himself. In most cases he appeared to have been the trainer. There was, in addition, a reserve man to each team. Each member of a team wore singlet, uniform trousers, braces or belt, plimsolls

and a cap bearing hi number in the team to assist the judges JO identifying indi\'idual members of the team, both in the land drill and in the water \\ ork. For water work swimming trunks were worn in addition. The competition was di\'ided into two principal sections, vi7 .. land drill and water work, each section being again sub-di\ ided. For the land drill te ts, which took place in the gymna ium, each team was required to demonstrate one or more of the three standard methods of release and one or more of the five standard methods of re cue, at the discretion of the judges, the competitors working in pairs. In addition, each team was required to perform artificial respiration (H- ) on the 'patient' provided. Having completed the land drill test, the team would then repair to the bath, where they would repeat in tbe water the release and rescue methods previously demonstrated in the gymnasium, still working in pairs. In the rescue tests the emphasi is on efficiency combined with speed, swimming free style but using the breast stroke during at lea t the last three yards of the approach. The recovery of an object from a depth of 8 ft. completed this part of the test. Perhaps the mo t interesting part of the whole competition took place after lunch, when an accident was staged on ' in the bath. The diving platform represented a bridge

spanning a ri\er. A man \\ as seen to fall from the bridge. \\ hen, after an imen at. a passer-by on the bridge. eeing the man in difficulties, plunged in to aye him. Both drownee and rescuer then appeared to be in difficulty. At this stage the competitors. again working in pairs. having been instructed that they were upposed to be constables patrolling the bank. were released from tbe other end of the bath. and were expected to grasp the iruation and act acccrdingly. The incident was well staged. At the presentation ceremony the chair was occupied by Capt. Hale. who was supported by Sir Henry Sluddy, C.RE., Vice-President of the Society and Chief Constable of the West Riding of Yorkshire. and Col. T. St. John on. C.RE., Chief Constable of Lanca hire. Capt. Hale. in welcomiog the team and \'isitor , said that he was particularly plea ed to see a team from Ulster competing thi year. He then decided to relie\'e their ten -ion by announcing the results immediately. and adopted the unique procedure of reading them in reverse, so that the winners were not revealed until the end. The re ults are given below. Responding to the chairmao's invitation to present the Trophy. Sir Henry expressed his pleasure at being there, and his thanks for the great honour \\ h ich he felt had been conferred upon him. In congratulating

RESULTS-MEN 1. 2. 3. 4. 5.

6. 7. 8. 9. 10. 11.

Land ResusWater Team drill citation work Lancashire Constabulary 144 81.3 * 230* West Riding Constabulary 146.6* 77.7 212.3 Northumberland Constabulary ... 129.6 73 210 .3 Metropolitan Police 'P' Div. 142 79 214 Portsmouth City Police .. , 142.3 76 214.3 Birmingham City Police ... 137.3 74 200.6 Glasgow City Polil;e 134 68 211.6 Cambridge City Police 138 73 209.3 Plymouth City Police 139.3 77 191 Cardiff City Police 137.3 68 208 Royal Ulster Con tabulary ... 126.3 . 66.7 .201.3 * Indicates highest marks m that section.

Staged accident 122.3 114.3 131.6* 109.3 107 127.3 124 113.3 123 .6 114.6 109.3

Total 577.6 550.9 544.5 544.3 539.6 539.2 537.6 533.6 530.9 522.9 503.6

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Cap"aii", Hale ro_g1-, :ae e e:-:;: [c 2. dose C! ·~a. :dng aU :he >c:ge-s j-or i1a ';:;;: cor:se:::ed to gi',"e ~;-~jr ~j"";'"'e ~~ai Qa.::.. -:-;.e J ...tcges .'e-e: Land d:-:::' E H \filli~·in. Es.q _ L::g::on-Sea: C. B. Sco~iJerr. Esq.. HexIe:.. Kent: E Jo;;;-.soG. Es~. Li\erpoo; Brar.ch. V:a.er '.;.Off: J. Poul-on. E:q. di:;-e or~o.J.C:ge. Central Exe ,j·.e: :\L Hopkin. Esq .. SOt.~h Wales Branch: K. Ta::lo:-. Esq .. Leeds Branch.

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Competition ReIXlrts on the Gas.. G.P .O. and u ex Open Competitions will appear in the next' e of thL journal-Januar:,February 19-58.

From a seat in the audience Some Random (and Proyocative) Comments on the Competitions Crand Prior

. ".earest house half mile away," accordIng to the card. Were all those in the "treet sho';m on the backcloth emptj ? A microphone over the stage '}.ould enable questions and ans'sers to be heard by the audience. and -,',ould be much appreciated. A crashed motor cycle would hardly be found standing upright. , What's up here? Accident?' Surely it was obvious. J'-:ow, Captain, which do you mean? A depression or a swelling? Judges must not prompt. What a long time they took to remove that bike. How often ' Remove to shelter' is forgotten. Inaccurate timing in nearly all cases of A.R. , Promote circulation' is now considered a waste of time. Was it necessary to search for scalds when they had seen what happened? Congratulations to the judge who WOULD insist upon silence in the audience. How he 'mauled' that 'sterile' dressing. , Is your wife out shopping?' Had they not been told that the patient lived alone? How anxious they all were to treat the charming Juliet. Was it necessary to send Juliet to hospital? 'We're first aiders.' They were in ambu lance uniform. Your' bedside manner' was excellent sergeant. , Raising lower limbs' in shock. ine to twelve inches are ample. The performance of' Romeo and Juliet ' was worthy of Sir Laurence Olivier and Vivien Leigh themselves, but we do not recall having seen Vivien Leigh knock the balustrade over.

We again sa'.'. those bits of conon '.':001 pushed in aftenl.ards. HUrT} by all mean. but don't rush . There is a difference. \Vhy did she try to mo\ e the motor cycle? It wasn't in the way. Had she adopted the correct technique she need not have struggled like that to tum the patient. A.R. should not be completely discontinued immediatel) upon the . breath Ing restored.' 'Human crutch." Was the first aider supporting the patient or the patient supporting the first aider? Why search the cupboards \\hen the soda bic. was staring at you from the open shelf? Serves you right ~ That's \\ hat happens ~hen you step over the stretcher. The team test was a step towards the . mass casualties' type. Casualties Union Why leave the engine running: One competitor ~()uJd not remember which ambulance he belonged to. It is a long time since we sa\\ the old circular water bottle. Surely the) were museum pieces. We saw one competitor trying to make a 'date' with the pretty patient. 'Bedside manner' was far from satisfactory.

-oeal uperfieial Anre the I

~e-i -.-euce'=[ J. J. ~filler.

\\'e \'. ere surprised to see a medical man [I} ing to restrain an epllep[ic.

\Ye a \1. only one team equipped with a ~;eil Robenson stretcher for the' manho:e ' [et. One competiror enquired 01- [he audience . Is [here a doctor in ~'le house? . Royal Li:fe SaYing ociety In H-); the backward mo\emenr hould :- nchronise with the Efr. One team ignored the blanke[-. de pHe the fact [hal they were pu hed right under [heir noses \\'hich is the best pOSH Ion [0 change knees? Some of the pats on baCK -hould ha\e been firmer. They ha\-e a definite function. There was a tendency on the pan of [he dro\\nees ro assist when bemg dragged our of the water. The whole bod\ hould ha\ e . been coml)Jetely relaxed. Once or t\\ ice orders were anticipated. Pull on arm should be up\\ard rather than backward in H-~. We would like to have een [he pa[iem placed in some a\\kward position . Why not repeat the land drill III quick time, with no pauses? We would suggest the attendance of a press photographer next year. A.R. competition did not include 'cm er patient.' This is a difficult manoem re_

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FIRST AID & NURSING, NOVEMBER/DECEMBER 1957

Book Reviews BAILLIERE'S NURSES' DICTIONARY Bailljere, Tindall & Cox, of 7 and 8 Henrietta Street, London, W.C.2, have published the fourteenth edition of this very ha ndy, pocket sized book at a price of 6/6. The last edition was published in J 953. This new edition is revised by Barbara F. Cape, S.R .N., S.C.N. There are 25 appendices. The book is most comprehensive, bearing in mind that it can be easily slipped in the coat pocket. The foreword is by Sir Cecil Wakeley, Bt., K.B.E., C.R, and he says: , I am very pleased to write a foreword to the new edition of this Nurses' Medical Dictionary for I have read through the proofs and I am certain that it is by far the best medical dictionary for nurses that I have seen. , There is a crispness and yet a lucid style throughout the book, and all the modern terms used in medical and nursing literature have been incorporated. The small line drawings are excellent and well chosen. There are twenty-five appendices at the end of the dictionary and they are quite a feature of the book and should prove of real value to the modern nurse who must be quite up-to-date to pass her State examination. The new appendices on radiotherapy and on static electricity and' antistatic precautions are outstanding and very practical. 'J can confidently recommend this dictionary not only to student nurses but to all nurses, for they will find it a guide and a friend on many occasions, as will V.A.D.s, the Civil Nursing Reserve and members of the many auxiliary services of the medical profession. Members of the British Red Cross and the St . John Ambulance and all first aid workers in the Civil Defence and in factories will find this dictionary a much used companion if they are wise enough to add it to their treasured possessions. , I would like to congratulate Miss Cape on this very excellent new edition.' NEW WALL CHART AND ILLUSTRATED DESCRIPTIVE BROCHURE Adam, Rouilly & Co., 18 Fitzroy Street, Fitzroy Square, London, W.l, have published the new Cbart No. 601G, 'Hypodermic Injection Technique, Subcutaneous and Intramuscular.' It is drawn and designed under the supervision of Professor C. F. V. Smout Birmingham University. ' . !h~ technique of making hypodermic llljectlOns both subcutaneous and intramuscular is told in simple language by means of a large chart in colour and in a fully illustrated brochure. Hypodermic injections are becoming increasingly common and the pitfalls for the unwary can be fraught with serious consequences. These publications are designed to impress upon the nurse the importance of following the correct technique and of exercising the ~t!ll0~t care w~en giving hypodermic lD]ectlOns to patlents. Beautifully coloured, mounted on cloth with plain rollers, complete with illustrated descriptive brochure, £2 2s. Parcel postage and packing (United Kingdom) 2/- extra.

FIRST AID & NURSING, NOVEMBER /DECEMBER 19S7

* First-Aider~s Crossword No. 31

10. II. 12. 13. IS. 16. 20.

'21. 23. 25.

28. 29. 30.

ACROSS Maximum amo~lil t of air expelled in one breath . .. . ., (S,8) Sense organ takes a guinea for London court (5) The' Sphyg , is a special typefor 30 .. . . .. (9) Unfortunately we may be down (6) on them. Sounds strange Mad tea for Juno's priestess ... (6) Definite statement. May be inflammatory! (2,2) Metabolic deficiency. Could this be running arrears? (6,4) Could well be the first-aider's ninth point . .. (10) Seaman with the French is bodily strong . . . (4) . .. but usu".iy doesn't stay long! ... (6) Do like overgrowth of scar tissue in healed wound (6) Death-like (9) Nothing to lend in a way then ... (S) Perhaps the sober old super worries about his ... (S,8)

2. 3. 4. S. 6. 7.

8. 9. 14. 17. 18. 19. 22. 24. 26. 27.

Chlorine is in constant use at the power .station lvhere I work. I lVould be obliged if y ou 'would detail first aid measures to be taken for any mishap caused by its use. We have Puretha respirators and Siebe Gorman compressed air respirators at th e station .

Answered by Dr. A. D. B€lilios R. G. J. (Rhondda) writes:A friend and I were discussing differing aspects of our lvork and a ques tion came up in our discussion on road accidents. When an accident happens l('ho is in charge of the casethe nurse or a qualified ambulance man. Would 1'0U be so kind as to settle our diffei-ence . Answer

I don't think th ere is a definite ruli ng and you must work in cooperation. At the risk of causing a further argument, I feel that the qualified ambulance man if experienced should take charge unless the nurse also possesses fir st aid certificates. First aid should be studied by doctors, nurses and laymen and should be a common ground on which they all can meet. With exceptions, however, this is not so, hence my opinion above. 1 could say a lot more but I had better

DOWN (9) I print our sudden action Sounds a sllre thing to be (6) definite A hundred take nothing to a (4) doctor then may part Breath may indicate 16 (4) Arrive finished. The antithesis ofa blackleg? .. (8) It is back to the tenth ... (S) Do they provide less ca lories every day (8, S) Certainly not an example of 8... (6, 7) Long process of nerve cell (4) Encouragement from the patient when applying arti ficial respiration (4) For a Rome bride to work? (9) It takes more than a backache to produce this mineral . .. (8) Victory day we French see dark red blood (6) Give credit to a waiting list to mOve slowly .. . (5) Soft for flattery (4) Unemployed doctor from Middle (4)

Answer

A big question! Summarised briefly (1 ) Personal protection while removing victim quickly from sources of danger (2) General principles, so far as applicab le, for the treatment of partial asphyxia (3) Absolute rest for the patient (4) Oxygen (5) Treatment of shock (6) Hospitalisation or doctor at scene of incident. J . M. (Montreal) writes:Here I am again with my queries but I alway s like to be able to answer a question \Vhen asked by my class. Unable to answer the t\Vo questions: (1) Why do \Ve not give aperients, e.g. castor oil, unless ordered by a doctor in case of poisons. (2) In case of lI eat exhaustion why do we use tepid water and not cold as in sunstroke? Thanks for your past co-operation.

Answer

My greetings onc_e again to Canada and particularly to your beautiful city. My answers to your questions :(1) It depends on the nature of the poison as to whether an aperient will be harmful, of value or of no effect. The S.l.A.A. chapter on the subject of poisons is in an abridged form hence does not indicate the types of cases mentioned above. (2) The two conditions are not quite the same as your book dessc: ribes. Heat exhaustion occurs in men, often in a lowered state of physical health and suffering from constipation, who are working in a hot environment. The circulatory system is embarrassed. His temperature moderately raised. If sponging is employed at all, the water should only be tepid since too drastic a treatment is not desirable. In sunstroke the body has been overheated and the temperature may go up to 112. It is urgently necessary to lower the temperature, hence cold sponging or even putting the patient into a cold bath in which there is floating ice. It must be emphasised that both are urgent conditions - as serious as heart attacks-and the treatment may have to be modified according to

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SOLUTION TO CROSSWORD No. 30 ACROSS 1, A pint of the best; 9, Air hunger; 10, Extra; 11, Chew ; 12, Inhalation; 14, Misery; 16, Excised; 18, Ominous; 20, Douche; 22, Accidental; 24, Ends, 27, Icing; 28, Retention; 29, Night blindness.

H. A. (Blackpool) writes:-

Queries

BDLJOLJOEJODODODOB [JBOBOBOBOBOBOBr~ EJOOOOBDDOOOCDOD OBOBOBOBOBOBOBO EJOOOOOB.BEJOOOOO OBOBOBEJBBBOB.=D LJOOOBLJODrJDOOLJ 0 O[IJOBLJBOBOBOBO 0 EJOODOOOOOOBLJOOO OB.BOBBIOBrJBOBO EJDEJDDOB. BEJOOOOO OBOBOBrJ=EJ. OBOBO rJOOOOOO OBEJOOOO ORO.OBO OBOBOBO BEJDOODOOODOOOOB 1.

not-I have probably said too much already!

Beader~

Compiled by W. A. Potter

DOWN 2, Purge; 3, Nous; 4, Organs; 5, Terrace; 6, Enema; 7, Extrinsic; 8, Trained person; 9, Accommodation; 13, Trio; IS, Stitching; 17, Clot ; 19, Sonefyl; 21, Wanton; 23, Digit ; 2S, Nails; 26, Anon.

We shall be pleased to send full details upon request.

I~~~~::::::::: E. 150-162

) l

& R. GARROULD L TD. ~~==========~I EDGWARE

ROAD.

LONDON,

W.2

f}RST AID & NURSING, NOVEMBER/DECEMBER 1957

what is available, e.g. there may be no ice.

it up unless Ire is convinced it is dangerous to his health. So wi!! you please solve his problem. for him.

J. R. H. (Saltburn) writes ;-

Answer Your question is of interest and great importance. Your friend has evidently become allergic to bee stings and is in danger of an alarming reaction should he be stung again. He should, therefore, take every precaution to prevent bee stings. His doctor may be able to fix him up with some tablets to be taken immediately if he is stung but I doubt if these can be as effective as an injection given by a doctor who, however, cannot usually be obtained sufficiently quickly jn such an emergency.

I have taken First Aid & Nursing for about 20 years, and 1 do enjoy reading same, especial1y the queries and answers. They are a source of valuable information and at one time we used to get a laugh from them! I have a query which 1 hope you will answer in your next publication if possible, please. I have a friend who keeps bees, and Iras kept them for many years and is an expert. He has been stung many times by them during the years he has kept them, but the last two or three times he has been stung he has had symptoms which have disturbed him. His nose and throat have clogged with mucous and breathing has become difficult, only for a short while, then the symptoms clear up. He is so deeply in love Ivith his hobby of bee keeping that he does not lVant to give

You say that your friend loves his hobby, etc. There is now a method of giving a course of injections to make him less sensitive to stings and if he wishes to continue he should consult his own doctor. Further information can be supplied on request.

FIRST AID & NURSING, NOVEMBER/DECEMBER ]957

What do You Know P No. ."1

Nineteenth Edition. Completely revised. 26/st thousand. 286 pp., 286 illustrations, some coloured, 6s. 6d., post 4d.

BOOKS FOR '

WARWICK AND TUNSTALL'S

ANSWERS

FIRST

t. A dressing that is germ-free. 2. Soak two thicknesses of linen or

FIRST AlDERS

AID

TO THE INJURED AND SICK Edited by A. P. GORHAM, M.B .• Ch.B., M.R.C.S.

of a clean handkerchief in cold water, wring out the compress until it does not drip when held up and then apply it to the affected part. 3. The inside fold of a clean handkerchief, or a piece of linen, or clean unprinted paper such as the inside of an envelope. 4. Soak three thicknesses of flannel or of lint in very hot water, wring the compress dry. shake it and apply it to the affected part. S. To afford support and rest to an upper limb. To prevent the weight of an upper limb pulling on or moving the chest, shoulder, or neck. 6. Three. Arm sling, collar and cuff sling and St. John sling. 7. By turning up and pinning the By lower edge of the coat. passing the hand inside the buttoned coat or waistcoat. Scarves, ties and belts may also be used. The sleeve can be pinned to the clothing. 8. In the treatment of a fractured collar-bone.

BAILLIERE'S HANDBOOK OF

Police Surgeon City and County of Bristol

First Aid and Bandaging

'FIRST AID' WALL DIAGRAMS 26 X 40 in.

by Arthur D. Belilios, M.B., B.S., D .P .H . , D. K. Mulvany, M.S., F.R.C.S . , F.R.C.P .I., and Katharine F. Armstrong, S.R.N ., S.C .M., D. N.

A- G Anatomy and physiology. H-J The triangular bandage. K. L The roller bandage. M, N Hzmorrhage and wounds. 0, P Dislocations and fractures. Q. R Transport. S, T Artificial respiration. Single Sheets: Linen - 75., plus postage. Paper - 55., plus postage. Set of 20, an Roller: Linen - 1505., post free . Paper -1005., post free.

The British Red Cross Society have specially adopted a set of 6 sheets, A, D, M, N, 0, P, which can be supplied on linen with fittings for the special price of 50s., plus postage.

This volul1i.e is wide in its scope; covering in addition to injuries, medical conditions of various kinds including poison, case-taking, medical cause of unconsciousness, internal haemorrhage, first aid in maternity cases, spinal injuries, asphyxia, industrial poisoning, the use of morphine. "Undoubtedly the best of its kind."- Nursing Mirror. Fourth Edition. 476 pages and 200 drawings. Price 8s. 6d. Postage 9d.

A HANDBOOK OF

Elementary Nursing

JOHN WRIGHT & SONS LTD., BRISTOL

by Arthur D. Belilios, M.B ., B.S ., D.P.H . and Dorothea Duncan-Johnstone, S. R ."i .

Miscellaneous Advertisements should be sent to First Aid &. Nursi"" 32 Finsbury Square, London, E.C.2. Rate 4d. per word, minimum 6s.

Box numbers Is. extra.

This is an ideal handbook for anyo ne who is called upon to carry out any form of emergency nursing. It describes in simple language the basic procedures of nursing and contains brief descriptions of the more common diseases, with general notes on the nursing required in each case. A chapter is devoted to the subject of home nursing. The whole book provides the essentials of nursing in a handy and comprehensive form. 314 pages. 61 drawings. Price 7s. 6d. Postage 9d.

" P LAS T I F0 L" PLASTIC

WOUND

REPLICAS

for First Aid Exercises SCENT CARDS . 250 18/6, 1,000 52/6. Tickets, Printed Pencils, Memos. Samples free. -TrCES, II Oaklands Grove, Lo ndon, W . 12. OUR NEW series of F.A. competition papers now ready. Team tests five for 5/6. l.ndividual tests eight for 5/ 6. Selby & Plowright, 135 Russell Street, Kettenng. DIVISIONAL SURGEON 'S Outfit S.J.A .B . 39 chest . 33 waist, hat 7. £10. Good condition. Box No. 776, 'Firs t Aid & Nursing,' 31 Finsbury Square, London, E.C.2.

E.S.P. TRAINING MODELS Is your Unit equipped with The ESP MINIATURE SKELETON? 26" high, scale model of the human skeleton. Wr:te now (or details of this and other valuable training aids

including:

SC~~~J~TRJ~E S~IES~il~~~~~~R~~E) MOTHERCRAFT DOLL HUMAN EYE HEART, EAR. ETC., ETC. Distributors for PLASTIFOL WOUND REPLICAS (No.2 Set now available) ANATOMY FLANNELGRAPH Prompt attention to all enquiries.

Illustrated brochure from

EDUCATIONAL & SCIENTIFIC PLASTICS LTD. 71 Brighton Road, Hooley, Coulsdon, Surrey Tel: Down land 240'2

Twelve months ago an entirely new idea for First Aid Training called" PLASTIFOL " was introduced and very enthusiastically received by all concerned with training programmes. Previously casualty faking made use of modelling clay and grease pajnt. Although effective, it was found that a considerable amount of time was wasted in modelling the wounds as they were so quickly damaged when treatment and bandaging took place. The Wound Replicas are made of soft Plastic material which is washable and lasts indefinitely. They can be temporarily attached to the skin with gum and used over and over again. During this year addi tional Replicas have been developed covering a wider range of injuries and a more comprehensive set containing 18 different replicas and known as the No.2 SET is now available. The use of these will add further interest to training courses. Sample axe wound, illustrations and notes may be obtained, postage paid, by sending remittance for 3/6d. BROWNING'S

LTD.

DEPT. Fl-69 ABERDEEN STREET, HULL, ENGLAND.

Bailliere, Tindall & Cox 7-8 HENRIETTA STREET, LONDON, W.C.2

RE.ADY NOVE.MBE.R A No. 601G.

NEW

"HYPODERMIC

Baillie re, Tindall & Cox Ltd.

INJECTION

7-8 Henrietta Street, LONDON, W .C.2

TECHNIQUE"

Subcutaneous and intramuscular Complete with Illustrated descriptive brochure £2. 2. O. Postage 2/ 6d.

CHART

ADAM, ROUILL Y & CO. Human Osteology, Anatomy. Etc. 18, FITZROY STREET, FITZROY SQUARE, LONDON, W.1 TELEPHONE: MUSEUM 2703

Dale, Reynolds & Co. Ltd. 32 Finsbury Square, LONDON, E.C.2

Please supply Copyjies First Aid and Bandaging Copyj ies Handbook of Elementary Nursing Postage 9d. extra per vo lume . Remittance enclosed value Name ............ .

Address .

A NEW ALL-METAL 2-STRETC·HER AMB - LANCE ON THE LAND ROVER 107 ·n~ W/B CHASSIS

THIS up-:o-date ambul~nce incorporates the latest aluminium alloy construction techniques to combine toughness with comfort, and has all the mobility and tenacity afforded by a 4-wheel drive. The design provides for two stretchers and an attendant, one stretcher and three sitting cases , or six sitting cases.

PILCHERS

AMBULANCE & MOBILE UNIT BUILDERS

314 Kingston Road, Wimbledon, S.W.20 Telephone: LiBerty 2350 & 7058

47 High Path, London, S. W.19 Telephone: LIBerty 3507

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