It therefore becomes the plain duty of Girl Scouts not only to be careful but to repair, if possible, the carelessness of others which may result in accident.

Let us review briefly some of the many small things in our daily lives which cause accidents, and therefore suffering and loss.

1. Carelessness in the Street. As, for example, taking chances in getting across in front of a car or automobile; running from behind a car without looking to see of some vehicle is coming from another direction; catching a ride by hanging on to the rear end of cars or wagons; getting off cars before they stop; getting on or off cars in the wrong way; being too interested to watch for open manholes, cellarways, sewers, etc.; reckless roller skating in the street, throwing things like banana peels on the street or sidewalk where people are likely to slip on them; teasing dogs, or trying to catch strange ones; many dogs resent a stranger petting them and use their only means of defense—biting. Other examples will occur to you of carelessness in the streets which space does not allow us to mention here.

Wait until the car stops before trying to get off. In getting off cars you should face in the direction in which the car is going. A simple rule is to get off by holding a rod with the left hand and putting the right foot down first. This brings you facing the front of the car and prevents your being swept off your feet by the momentum of the car.

If you see any refuse in the street which is likely to cause an accident, either remove it yourself or report it to the proper authorities to have it removed at once.

2. Carelessness at Home. As for example, starting the fire with kerosene; leaving gas jets burning where curtains of clothing may be blown into the flame; leaving clothing or paper too near a fire; throwing matches you thought had been put out into paper or other material which will catch fire easily; leaving oily or greasy rags where they will easily overheat or take fire spontaneously; leaving objects on stairs and in hallways which will cause others to fall; leaving scalding water where a child may fall into it or pull it down, spilling the scalding water over himself; leaving rags or linoleum with upturned edges for someone to fall over; and innumerable other careless things which will occur to you.

3. Disobedience, playing with matches; building fires in improper places; playing with guns; trying the "medicines" in the closet; throwing stones; playing with the electric wires or lights; playing around railroad tracks and bridges: We could multiply the accidents from disobedience indefinitely. Remember, a caution given you not to do something means there is danger in doing it, which may bring much sorrow and suffering to yourself and others.

It is a very old saying that "An ounce of prevention is worth a pound of cure," but it is as true today as it was hundreds of years ago.

After the Accident

When the time for prevention is past, and the accident has happened, then you want to know what is the best thing to do, and how best to do it in order to give the most help and relief immediately, before expert help can arrive, and to have the victim in the best condition possible for the doctor when he comes, in order that he may not have to undo whatever has been done before he can begin to give the patient relief from his suffering.

1. Keep cool. The only way to do this effectually is to learn beforehand what to do and how to do it. Then you are not frightened and can do readily and with coolness whatever is necessary to be done.

2. Send at once for a doctor, if you have a messenger, in all except the minor accidents. This book will help you learn to judge of whether a doctor will be necessary. If in doubt send for a doctor anyway.

3. Prevent panic and keep the crowd, if there is one, at a distance. The patient needs fresh air to breathe, and space around him.

4. Loosen the clothing, especially any band around the neck, tight corsets or anything else that may interfere with breathing.

5. Keep the patient flat on his back if the accident is at all serious, with the head slightly down if his face is pale and he is faint, or slightly raised if his face is flushed and he is breathing heavily, as though snoring.

6. If there is vomiting, turn the head to one side in order that the vomited material may easily run out of the mouth and not be drawn into the windpipe and produce choking to add to the difficulties already present.

7. Remove clothing, if necessary, gently and in such manner as to give the patient the least amount of suffering. Move any injured part as little as possible. At the same time, as a secondary consideration, injure the clothing as little as possible. If, as often, it becomes necessary to cut off the clothing, it may be possible to rip up a seam quickly instead of cutting the cloth, but saving the clothing is always secondary to the welfare of the patient. Little or no consideration should be shown for clothing where it is necessary to keep the patient motionless, or where quick action is needed.

8. Transportation. There are three methods for emergency transportation of accident victims which can be used according to the degree of the injury:

(a) Fireman's Lift. If it is necessary for one person to carry a patient, it is easily possible to lift and carry quite a weight in the following manner:

First, turn the patient on his face, then step astride his body, facing toward his head, and, with hands under his armpits, lift him to his knees, then clasp your hands over the patient's abdomen and lift him to his feet; then draw his left arm around your neck and hold it against the left side of your chest, the patient's left side resting against your body, and supporting him with your right arm about the waist. Then drop the patient's left hand and grasp his right wrist with your left hand and draw the right arm over your head and down upon your left chest; then stooping, clasp his right thigh with your right arm passed between the legs (or around both legs) and with a quick heave lift the patient to your shoulders and seize his right wrist with your right hand, and lastly, grasp the patient's left hand with your left hand to steady him against your body. (Work this out with a companion as you read it.)

(b) A seat made of four arms and hands (which you have no doubt used in your play), may be used for the lesser injuries. If the patient can, he supports himself by putting his arms around the necks of his carriers, each of whom in the meantime grasps one of his own wrists and one of his partner's. This makes a comfortable seat for carrying. If the patient needs supporting, a back may be improvised by each carrier grasping the other's arm below the shoulder to form the back and their other hands clasped to form the seat. A better seat may be made with three hands clasping the wrists, while the fourth arm is used as a back, by one clasping the other's arm below the shoulder. This does not provide a very secure back, however, as it is not easy to hold the arm against much of a weight from the patient's body.

(c) Improvised Stretcher. When the patient shows any sign of shock, is unconscious, has a serious fracture of some bone or bones, has a serious injury to any part of the body, or is bleeding excessively, he must be carried lying down. It may be that there will be no regular stretcher at hand. In that case one must be improvised. A serviceable one can be made from ordinary grain or flour bags by cutting the two corners at the bottom and running two poles inside the mouth of the bags and through the holes.

A workable stretcher can be made from coats by turning the sleeves inside out, passing the poles through the sleeves and buttoning the coat over the poles. This brings the turned sleeves on the inside. A five-bar gate or a door, if it can be gotten without delay, also make satisfactory emergency stretchers.

A stretcher may also be made out of dress skirts, with or without poles. Put the skirts together, bottoms slipped past each other, and slip the poles through, as with the bags. If no poles are available, roll the edges of the skirts over several times to form a firm edge, and carry with two or four bearers, as the size and weight of the patient make necessary.

Minor Injuries and Emergencies

Minor injuries may or may not need the aid of a doctor, and you must learn to use judgment as to the necessity of sending for one. We will consider these minor injuries in groups to remember them more easily.

1. (a) BRUISES; (b) STRAINS; (c) SPRAINS

(a) A Bruise is produced by a blow which does not break the skin, but does break the delicate walls of the capillaries and smaller veins, thus permitting the blood to flow into the surrounding tissues, producing the discoloration known as "black and blue."

(b) A Strain is produced by the overstretching of muscles or ligaments, or both, but not tearing them. It may or may not be accompanied by breaking of capillary walls with discoloration. Any muscle or ligament may be strained.

(c) A Sprain is produced by the overstretching of the muscles or ligaments or both about a joint. There may also be some tearing of the fibres or tearing loose from their attachments. This always breaks capillaries or small veins, making the surface black and blue. This discoloration usually appears some time after the accident, because the broken blood vessels are far below the surface.

Treatment—For bruises and strains it is seldom necessary to call a doctor. Apply cold, either by wringing cloths out of cold water and applying, or by holding the injured part under the cold water tap. Do this at intervals of several hours, until the pain is lessened. The cold may be alternated with hot water which must, however, be quite hot, just enough not to burn, as lukewarm water is almost useless. Some patients will prefer to use only hot water. The water followed by applications of tincture of arnica, witch hazel, or alcohol and water, half and half, and bandaging will be sufficient.

If, however, there has been no black and blue at first, as in a bruise, but it begins to show later, and the pain continues severe, and there is a good deal of swelling, then you should send for a doctor, as more than first aid is needed.

In case of sprain, send for a doctor, and in the meantime elevate the joint and apply hot or cold water, or alternate hot and cold, as patient prefers. This will give relief by contracting the blood vessels.

2. (a) BURNS; (b) SCALDS; (c) SUNBURN; (d) FROSTBITE

(a) Burns are produced by dry heat, as a fire, acids, alkalis, etc., and may be of all degrees, from a superficial reddening of the skin to a burning of the tissues to the bone.

(b) Scalds are produced by moist heat, and may be of the same degrees as those produced by dry heat.

(c) Sunburn is produced by the sun, and is usually superficial, but may be quite severe.

(d) Frostbite is produced by freezing the tissues and is usually not dangerous. The more severe types will be treated later under Freezing.

Treatment—(a) Burns; (b) Scalds

1. Except in the minor burns and scalds, send for the doctor at once.

2. The first thing to do is allay pain by protecting the injured part from the air.

3. For a burn produced by fire, cover with a paste made of baking soda and water, or smear with grease—as lard, carron oil (mixture of linseed oil and lime water—half and half) or vaseline or calendula cerate. Cover with a piece of clean cloth or absorbent gauze and bandage loosely or tie in place. Gauze prepared with picric acid, if at hand, is a most satisfactory dressing. It can be purchased and kept on hand for emergencies.

4. In burns from alkalis or acids, wash off as quickly as possible and neutralize (make inactive the acids with baking soda, weak ammonia or soapsuds; the alkalis with vinegar or lemon juice). Afterward treat like other burns.

(c) Sunburn is an inflammation of the skin produced by the action of the sun's rays and may be prevented by gradually accustoming the skin to exposure to the sun. It is treated as are other minor burns.

(d) Frostbite—Prevention—1. Wear sufficient clothing in cold weather and keep exposed parts, such as ears and fingers, covered.

2. Rub vigorously any part that has become cold. This brings the warm blood to the surface and prevents chilling.

3. Keep in action when exposed to the cold for any length of time. The signs of danger are sudden lack of feeling in an exposed part, and a noticeably white area. Chilblain is an example of frostbite.

Treatment—The circulation of the blood through the frozen part must be restored gradually. This must be done by rubbing the part first with cold water, which will be slightly warmer than the frozen part, and gradually warming the water until the circulation and warmth is fully restored. Then treat as a minor burn. If heat is applied suddenly it causes death of frozen parts.

3. SPLINTERS, SMALL CUTS, SCRATCHES AND PIN PRICKS

None of these injuries will usually require a doctor if properly treated in the beginning. The bleeding from any of them is not sufficient to be dangerous. But whenever there is a break in the skin or mucous membrane there is danger of infection by germs, and this is what makes the first aid treatment in these cases so important. A tiny scratch is sometimes converted into a bad case of blood poisoning by not being properly treated at first.

Splinters should be removed by using a needle (not a pin) which has been sterilized by passing it through a flame (the flame of a match will do if nothing better is at hand). After the splinter is out, the wound is treated like a cut or scratch.

The germs which produce poisoning do not float in the air, but may be conveyed by any thing which is not sterile, as, for instance, the splinter or the instrument that did the cutting, scratching or pricking. They may be carried to the scratch by our hands, by water, or cloth used for dressings.

Treatment—Wash your own hands thoroughly with soap and water, using a nail brush. Clean the injured part well with disinfectant, as, for instance, alcohol and water, half and half, or peroxide of hydrogen—paint the spot with iodine, and cover with sterile gauze (if this is not to be had, use a piece of clean cloth that has been recently ironed), and bandage in place. If the bleeding is severe, a little pressure with the bandage over the dressing will stop it. Use the same precautions if the wound has to be re-dressed.

4. STINGS AND BITES OF INSECTS

The poison injected by the sting or bite of an insect is usually acid, and the part should be washed at once with a solution of ammonia or soda (washing soda) to neutralize the poison. Then apply a paste of soda bicarbonate (baking soda) or wet salt and bandage in place. If the sting is left in the wound it must be pulled out before beginning treatment.

5. FOREIGN BODIES IN THE (a) EYE (Cinder) (b) EAR (Insect), (c) NOSE (Button)

(a) Eye—If a cinder, eyelash, or any tiny speck gets into the eye it causes acute pain, and in a few minutes considerable redness.

Treatment—Do not rub the eye, as this may press the object into the tender cornea so that it can be removed only with difficulty and by a physician. First close the eye gently, pull the eyelid free of the ball, and the tears may wash out the speck. If this is not successful, close the eye, hold the lid free, and blow the nose hard. You may then be able to see the speck and remove it with a bit of clean cotton or the corner of a clean handkerchief. If the object is lodged under the lid, and the foregoing efforts do not dislodge it, proceed to turn the lid up as follows:

Ask the patient to look at the floor, keeping the eyeball as stationary as possible. Take a clean wooden toothpick or slender pencil, wrapped with cotton, place on the upper lid about one-fourth of an inch from the edge, grasp the eyelashes with the other hand, give a slight push downward toward the cheek with the toothpick, a slight pull upward on the lashes and turn the lid over the toothpick. Remove the speck and slip the lid back in position. Wash the eye with boric acid solution.

If you are still unable to dislodge the body, discontinue any further efforts, apply a cloth wet in cold boric acid solution and send for the doctor. Anything done to the eyes must be done with the greatest gentleness.

If an acid has entered the eye, neutralize it with a weak solution of soda bicarbonate in water. If an alkali (lime) is the offending substance, neutralize by a weak vinegar solution. Follow in each case with a wash of boric acid solution.

(b) Ear (Insect); (c) Button in Nose—Foreign bodies in the ear and nose are not very common.

But sometimes a child slips a button or other small object into these cavities, or an insect may crawl in. Drop in a few drops of sweet oil and if the object comes out easily, well and good. If not, do not keep on trying to extract it, for fear of greater injury. Send for the doctor.

6. IVY AND OAK POISONING

There is a poison ivy (or poison oak) which is very poisonous to some people, and more or less so to all people. The poison ivy has a leaf similar to the harmless woodbine, but the leaves are grouped in threes instead of fives. The poison given off by these plants produces a severe inflammation of the skin. In the early stages it may be spread from one part of the body to another by scratching.

Treatment—Wash the irritated surface gently with soap and water, and then apply a paste of soda bicarbonate or cover quickly with carbolated vaseline. Another remedy is fluid extract grindelia robusta, one dram to four ounces of water. Sugar of lead and alcohol have also been found useful. For severe cases consult a doctor, especially if the face or neck or hands are affected.

7. (a) FAINTING; (b) HEAT EXHAUSTION

(a) Fainting is caused by lack of blood in the brain, and usually occurs in overheated, crowded places, from fright or from overfatigue.

Symptoms—1. The patient is very pale and partially or completely unconscious.

2. The pulse is weak and rapid.

3. The pupils of the eyes are normal.

Treatment—1. If possible put the patient flat on his back, with the head slightly lower than the rest of the body.

2. If there is not room to do this, bend the patient over with his head between the knees until sufficient blood has returned to the brain to restore consciousness.

3. Then get the patient into the fresh air as soon as possible.

4. Keep the crowd back.

5. Loosen the clothing about the neck.

6. Apply smelling salts to the nose.

7. When the patient has recovered sufficiently to swallow, give him a glass of cold water, with one-half teaspoonful of aromatic spirits of ammonia if necessary.

(b) Heat Exhaustion is exhaustion or collapse due to overheating where there is not sufficient evaporation from the surface of the body to keep the temperature normal.

Symptoms—1. The patient is usually very weak.

2. The face is pale and covered with a clammy sweat.

3. The pulse is weak and rapid.

4. The patient is usually not unconscious.

Treatment—1. Remove the patient to a cool place and have him lie down.

2. Loosen the clothing.

3. Give him a cold drink to sip.

4. Put cold cloths on his head.

5. Send for the doctor.

6. If necessary, give stimulant as in fainting.

8. (a) CHOKING: (b) HICCOUGH

(a) Choking—Choking is produced by something lodged in the throat, does not require artificial respiration, but a smart slap on the back to aid in dislodging whatever is blocking the air passage. It may be necessary to have the patient upside down, head lower than feet, to aid in getting out the foreign body. This is a comparatively simple matter with a child, but is not so easy with an adult. When the object is not too far down the throat it may be necessary for someone to use his fingers to pull out the offending substance to keep the patient alive until the doctor can arrive. In this case wedge the teeth apart with something to prevent biting before trying to grasp the object.

(b) Hiccough—This is usually due to indigestion or overloading of the stomach. Holding the breath for one-half minute will usually cure it, as it holds quiet the diaphragm (the large muscular and fibrous partition between the chest and abdomen), and overcomes its involuntary contractions which are causing the hiccoughs. A scare has the same effect sometimes. If the hiccoughs still continue troublesome after these simple remedies try to cause vomiting by drinking lukewarm water, which will get rid of the offending material causing the hiccough, and relieve the distress.

9. NOSE BLEED

The ordinary nose bleed will soon stop from the normal clotting of the blood and does not require treatment.

(a) Keep head elevated, with patient sitting up if possible. Do not blow the nose, as this will dislodge any clot which may have formed, and the bleeding will begin again. Any tight collar around the neck should be loosened.

(b) If the bleeding seems excessive, apply cloths wrung out of ice water to the back of the neck and over the nose.

(c) If the bleeding still continues and is abundant, pack the nostril with a cotton or gauze plug. Pack tightly (with a blunt end of a pencil if nothing else is at hand) and send for the doctor at once.

Major Injuries and Emergencies

1. (a) DISLOCATIONS; (b) FRACTURES

(a) Dislocations—In a dislocation the head of a bone is pushed or pulled out of its socket. A person may be falling and in trying to save himself catch hold of something in such a way that he feels a sharp, sudden, severe pain, and may even feel the head of the bone slip out at the shoulder or elbow.

Symptoms—1. When you looked at the injured part it does not look like the other side.

2. If you attempt to move it you find it will no longer move as a joint does, but is stiff.

3. There is great pain and rapid swelling usually.

4. There may or may not be black and blue spots around the joint.

Treatment—Send for a doctor at once. While waiting for the doctor, place the patient in the easiest position possible, and apply hot or cold cloths, frequently changed, to the injured part.

In dislocation of the jaw it may be necessary for someone to try to replace it before the doctor arrives. The mouth is open and the jaw fixed. The patient may even tell you he has felt the jaw slip out of its socket. Wrap your thumbs in cloth to prevent biting when the jaw snaps back in place. Place the thumbs on the tops of the lower teeth on each side, with the fingers outside, and push firmly down until the head of the bone can slip over the edge of the socket into place. As you feel the bone slipping into place, slide your thumbs out to the inner side of the cheek to prevent biting when the jaws snap together with the reducing of the dislocation.

(b) Fractures—Broken bones—There are two classes of fractures:

1. Simple—In a simple fracture the bone is broken, but the skin is not broken; that is, there is no outward wound.

2. Compound—In a compound fracture not only is the bone broken, but the jagged ends pierce through the skin and form an open wound. This makes it more dangerous as the possibility of infection by germs at the time of the accident, or afterward, is added to the difficulty of the fracture.

Symptoms—As in dislocation, you should be familiar with the main symptoms of a broken bone.

1. When you look at the injured part it may or may not look like its mate on the other side. In the more severe fractures it usually does not.

2. When you try to move it you find more motion than there should be, if the bone has broken clear through; that is, there will seem to be a joint where no joint should be.

3. The least movement causes great pain.

4. The swelling is usually rapid.

5. The discoloration (black and blue) appears later; not at once, unless there is also a superficial bruise.

6. The patient is unable to move the injured part.

7. You may hear the grate of the ends of the bone when the part is moved, but you should not move the injured bone enough to hear this, especially if the limb is nearly straight; the detection of this sound should be left for the doctor.

Treatment—Send for a doctor at once, and if it will be possible for him to arrive soon, make the patient as comfortable as possible and wait for him. However, if it will be some time before the doctor can arrive you should try to give such aid as will do no harm and will help the sufferer.

You must handle the part injured and the patient with the utmost gentleness to avoid making a simple fracture into a compound one, or doing other injury, and also to give him as little additional suffering as possible. You will need to get the clothing off the part to be sure of what you are doing. Rip the clothing in a seam if possible when the fracture is in an arm or leg, but if this cannot be done, you will have to cut the material. Do not try to move the broken bone trying to get off a sleeve or other part of the clothing.

With the greatest gentleness put the injured part, for instance, the arm or leg, as nearly as possible in the same position as the sound part, and hold it in that position by splints. Do not use force to do this. There is no great hurry needed to set a broken bone. The important point is to get it set right, and this may better be done after complete rest of several days, allowing for the passing of the inflammation.

The Most Important "What Not to Do Points" for Fractures Are:

1. If there is reason to think a bone may be broken try in all ways to prevent motion at point of fracture lest it be made compound.

2. Do not go hunting for symptoms of fracture (such as the false point of motion or the sound "crepitus") just to be sure.

3. The best treatment is to try to immobilize the part till the doctor comes.

Splints—Anything that is stiff and rigid may be used for splints. Shingles, boards, limbs of trees, umbrellas, heavy wire netting, etc. Flat splints are best, however. All splints should be padded, especially where they lie against a bony prominence, as for instance, the ankle or elbow joint.

If the patient is wearing heavy winter clothing this may form sufficient padding. If not, then other cloth, straw or leaves may be used. Cotton batting makes excellent padding but if this is not to be had quickly, other things can be made to do to pad the first rough splints which are applied until the patient can reach a doctor or the doctor arrives on the scene of the accident.

In applying splints remember they must extend beyond the next joint below and the next joint above, otherwise movement of the joint will cause movement of the broken part.

The splints are tied firmly in place with handkerchiefs, strips of cloth, or bandages, tied over splints, padding and limb. Do not tie tight enough to increase the pain, but just enough to hold the splints firmly. Do not tie directly over the break. There must be an inner and outer splint for both the arms and the legs.

2. (a) SERIOUS WOUNDS; (b) SERIOUS BLEEDING

Send for the doctor at once, and then stop the bleeding and keep as clean as possible till he arrives.

Dangers—1. In any wound with a break in the skin, there is the danger of infection or blood poisoning, as you have already learned.

2. In serious wounds through the skin, flesh and blood vessels there is also the danger of severe bleeding, with the possibility of the patient's bleeding to death.

Infection—You already know how the germs which can cause the blood poisoning get into the wound.

(a) by the object that makes the wound

(b) from the clothing of the patient through which the wound is made

(c) from the rescuer's hands

(d) from the water which has not been sterilized used in washing the wound

(e) from dirty dressings, that is, dirty in the sense that they have on them germs which can get into the wound and cause infection or blood poisoning.

The first two of these chances the Girl Scout will not be able to control. The last three she can to some extent prevent. Do not wash, touch or put anything into a serious wound unless a doctor cannot be found. Only this sort of thing justifies running risk of infection. Otherwise just put on a sterile dressing and bandage. In reality washing wounds only satisfies the aesthetic sense of the operator without real benefit to the patient in many cases. If a wound has to be cleansed before the doctor comes use boiled water; if this cannot be had at once, use water and alcohol half and half.

1. Always wash your hands thoroughly with water, soap and a nail brush, unless there is necessity for immediate help to stop bleeding which admits of no time to clean one's hands. Be sure your nails are clean.

2. Try not to touch the wound with your hands unless it is absolutely necessary.

3. Many wounds do not have to be washed, but dressing may be applied directly.

4. Having cleansed the wound as best you can, or all that is necessary, apply sterile cloth for dressing. This may be gotten at a drug store in a sterile package ready for use immediately, and is very satisfactory. If, however, these cannot be had, remember any cloth like a folded handkerchief that has been recently washed and ironed is practically sterile, especially if you unfold it carefully and apply the inside which you have not touched, to the wound. Bind the dressing on with a bandage to keep in place until the doctor arrives.

(b) Serious Bleeding:

It is important that you should learn what is serious bleeding and this will often help you to be cool under trying circumstances.

As you learned in your work in minor emergencies, the bleeding from the small veins and capillaries is not usually sufficient to be dangerous, and the pressure of the dressing when put on and bandaged in place will soon stop it. It may sometimes be necessary to put more dressing outside of that already on (called re-inforcing it) and bandage again snugly. But if you have made sure first that there is no large vein or artery cut, you need not be troubled for fear there will be serious bleeding before the doctor arrives.



Bleeding from an Artery: If an artery is cut the blood spurts out, the size of the stream depending on the size of the artery cut. This is the most serious bleeding because the heart is directly behind, pumping the blood through the artery with all its power. If it is a small artery the pressure with the finger between the cut and the heart for a few minutes will give the blood time to clot behind the finger and form a plug. This will stop the bleeding aided by pressure of the bandage. If it is a larger vessel the force in the heart muscle pumping the blood will force out any plug formed by the finger there, as the finger tires too easily.

Tourniquet: In this case it will be necessary to put on a tourniquet to take the place of the finger until a clot can form in the vessel big enough and strong enough to prevent the force of the blood current from pushing it out. This of course can be used only on the legs or arms.

A tourniquet is something put on to make pressure on a blood vessel to stop serious bleeding. There are five points to remember about a tourniquet:

1. It must be long enough to tie around the limb—a big handkerchief, towel or wide bandage.

2. There must be a pad to make the pressure over the artery greater than on the rest of the limb—a smooth stone, a darning ball, a large cork, cloth folded into a large pad or a rolled bandage.

3. The pad must be so placed that the artery lies between pad and the bone on the limb, in order that the pressure may stop the flow of blood by forcing the walls of the artery together between the pad and the bone.

4. Unless the tourniquet is put on tight enough, its application increases bleeding. It is extremely rare to find a tourniquet put on tight enough. In almost every such case removing the tourniquet will stop or partly lessen bleeding. A short stick or handle is needed, about a foot long, with which to twist the tourniquet sufficiently to stop the flow of blood. Usually it cannot be twisted tightly enough by hand alone. Tie the twisted part firmly so it will not slip, after it has been made tight enough to stop bleeding.

5. Remember, a tourniquet stops most of the circulation below it as well as in the cut artery, and must not be left in place too long for fear of injury to the rest of the limb by cutting off the circulation. Usually it should not be left on for more than an hour.

Bleeding from Veins—Bleeding from the veins is not so dangerous as from an artery. The blood from the heart has to go through the little capillaries before it gets into the veins, and therefore the force of the heart muscle on the blood in the veins is not so great as in the arteries. The blood does not spurt out, but flows out as it would from a bottle tipped on its side.

You have already learned what to do to stop the bleeding from the smaller veins, and that it is not serious. From the larger veins, however, it can be very serious, and it may be necessary for you to put on a tourniquet before the doctor arrives in order to save the patient's life.

Almost always bleeding from a vein can be controlled by clean gauze or handkerchief pad and pressure by hand directly over the bleeding wound. Tourniquets are almost never needed in bleeding from a vein. If necessary, it is wisest to apply them in the same way as for arterial hemorrhage and stop the circulation in the whole limb.

It is important to know in a general way where the blood vessels are in order to put the pad over them to stop the bleeding. Roughly speaking, the artery of the arm runs down about in a line with the inner seam of the coat. The large vein lies close beside it, carrying the blood back to the heart. The artery and vein of the leg run about in a line with the inside seam of a man's trousers.

Stimulants—In serious bleeding of any kind do not give stimulants until the bleeding has been stopped, as the stimulants increase the force of the heart and so increase the flow of blood. After the tourniquet is on and bleeding is stopped, if the patient is very weak, he may have a teaspoonful of aromatic spirits of ammonia in half a glass of water.

(a) SHOCKS; (b) APOPLEXY; (c) CONVULSIONS

(a) Shocks—In any injury, except the slight ones, the ends of the nerves in the skin are bruised or jarred. They send this jar along the nerves to the very delicate brain. The blood is drawn from the brain into the larger blood vessels, and the result produced is called shock. If you have jammed your finger in a door sometime, perhaps you have felt a queer sick feeling and had to sit down. A cold sweat broke out all over you, and you were hardly conscious for a moment or two. This was a mild case of shock. In more severe injuries a shock to the brain may be very serious.

Symptoms of Shock—1. The patient may or may not be unconscious, but he may take no notice of what is going on around him.

2. The face is pale and clammy.

3. The skin is cold.

4. The pulse is weak.

5. The breathing is shallow.

In any serious injury the shock is liable to be severe and will need to be treated before the doctor arrives.

Treatment—Send for the doctor if serious.

1. Lay the patient flat on his back with head low, so that the heart can more easily pump the blood back into the brain.

2. Cover warmly; if they can be gotten, put around him several hot water bottles or bricks, being extremely careful to have them covered so that they will not burn him. Persons suffering from shock are more easily burnt than usual. Do not put anything hot next him unless it can be held against your own face for a minute without feeling too hot.

3. Rub the arms and legs, toward the body, but under the covers.

4. Give stimulants only after the patient has recovered enough to swallow, and when there is no serious bleeding.

Stimulants—Strong, hot coffee, or a half teaspoonful of aromatic spirits of ammonia in a half glass of warm water. The latter may be given if the coffee is not ready.

(b) Apoplexy—When a person has a "stroke" of apoplexy send for the doctor at once.

This condition resembles shock only in that the patient is unconscious. The blow to the delicate brain does not come from the outside along the nerves, but from the inside by the breaking of a blood vessel in the brain, letting the blood out into the brain tissue and forming a clot inside of the brain, and thus making pressure which produces the unconsciousness.

Symptoms of Apoplexy—1. The patient is unconscious.

2. The face is usually flushed—red.

3. The skin is not cold and clammy.

4. The pulse is slow and full.

5. The breathing is snoring instead of shallow.

6. The pupils of the eye are usually unequally dilated.

Treatment—1. Lay the patient flat on his back with head slightly raised.

2. Do not give any stimulants.

3. Wait for the doctor.

(c) Convulsions—This condition resembles the foregoing shock and apoplexy in that the patient is unconscious.

Symptoms of Convulsions—1. The patient is unconscious.

2. The face is usually pale at first, but not so white as in shock, and later is flushed, often even purplish.

3. The skin is not usually cold.

4. The breathing may be shallow or snoring.

5. There are twitchings of the muscles of the face and body or a twisting motion of the body.

6. The pulse may be rapid, but is usually regular.

7. The mouth may be flecked with foam.

8. The pupils of the eye may be contracted or equally dilated.

Treatment—Convulsions come from various causes, and are always serious, therefore send for the doctor at once.

1. Put a wedge of some kind between the teeth if possible, the handle of a spoon protected by a cloth cover, or a rolled napkin does well. This is to prevent biting the tongue, which the patient is apt to do in unconsciousness with convulsive movements.

2. Lay the patient flat on his back, and prevent him from hurting himself in his twisting, but do not try to stop convulsive movement. It will do no good.

3. No stimulant is needed.

(a) SUNSTROKE; (b) FREEZING

(a) Sunstroke—Sunstroke is caused by too long exposure to excessive heat, or to the direct rays of the sun, and is much more serious than heat exhaustion, which you have already studied.

Prevention—Do not stay out in the direct sunlight too long on a hot summer day. Wear a large hat which shades the head and face well, if obliged to be in the hot sun for any length of time. Do not wear too heavy clothing in the hot weather. Leaves or a wet sponge in the top of the hat will help to prevent sunstroke. Drink plenty of cool water between meals.

Symptoms of Sunstroke—1. The patient is unconscious.

2. The face is red.

3. The pupils large.

4. The skin very hot and dry, with no perspiration.

5. The pulse is full and slow.

6. The breathing is sighing.

Treatment—1. Get the patient into the shade where it is as cool as possible.

2. Send for the doctor.

3. Remove the greater part of the clothing.

4. Apply cold water or ice to the head, face, chest and armpits.

Often the patient recovers consciousness before the doctor arrives; give cold water to drink; never stimulants.

(b) Freezing—This is a much more serious condition than frostbite, which you have studied, but only because more of the body is frozen and the tissues are frozen deeper. Much more care must therefore be taken to prevent bad effects after the thawing-out process.

Symptoms of Freezing—1. The patient may or may not be unconscious.

2. The frozen parts are an intense white and are without any feeling or motion.

Treatment—Send for the doctor at once.

1. Take the patient into a cold room.

2. Remove the clothing.

3. Rub the body with rough cloths wet in cold water.

4. Very gradually increase the warmth of the water used for rubbing.

5. Increase the temperature of the room gradually.

6. When the patient can swallow, give him stimulants.

7. When the skin becomes more normal in color and the tissues are soft, showing that the blood is once more circulating properly through the frozen flesh, cover the patient warmly with hot bottles or bricks outside of the bed clothing, or wraps, and give hot drinks. In using hot water be sure it is not too hot.

Dog Bite[3]

In the case of the dog bite we have a more or less extensive break in the skin and sometimes a deep wound in the flesh, through which the poison of hydrophobia, which is a living virus or animal poison, may be introduced, to be taken up slowly by the nerves themselves, reaching the central nervous system in about forty days. The slowness and method of this absorption renders the use of a ligature useless and unsafe. The treatment for dog bite is therefore as follows:

Immediate. Send for a physician, telling him the reason. While waiting, treat as any similar wound from any cause. If the skin is not penetrated, but scratched only, apply iodine and a sterile or wet dressing. If the skin is penetrated, the treatment should be the same as for a wound made by a dirty nail: that is, a small stick, such as a match, whittled to a point, with a little cotton twisted on the point, should be dipped into tincture of iodine, and twisted down into the full depth of the wound, and then done a second time.

Subsequent. A physician should be consulted immediately, and if there is any suspicion of the dog being sick it should be kept under observation. The body of a dog that has been killed under suspicion of rabies or hydrophobia, should be sent as soon as possible to the proper authorities.

One of the greatest discoveries in medical science is the Pasteur treatment for the prevention of hydrophobia after mad dog bite, and fortunately, provision for this treatment is so widespread that practically every one in civilized regions needing it, can have it, as is well known to all physicians. The fact that the period of development of the disease is so long makes the possibility of prevention greater.

It is never proper to suck a dog bite, because the merest scratch or break in the surface, even if too small to notice, will serve as a portal of entry for the living virus of rabies.

Snake Bite. For treatment of snake bite see page 297.

WATER ACCIDENTS

When it is possible, Girl Scouts should learn to swim well. It is fear when suddenly thrown into the water that causes so many of the deaths by drowning, and learning to swim well takes away this fear. A Girl Scout should also learn how to prevent accidents, and how best to help the victims of accidents in the water.

PREVENTION

Below are five rules for preventing drowning accidents.

1. Do not change seats in a canoe or rowboat.

2. Do not rock the boat.

3. Do not go out alone in a canoe, rowboat or sailboat unless you are thoroughly competent to manage such a boat, in a sudden squall or storm.

4. Very cold water exhausts a swimmer much quicker than warm water, therefore do not take any chances on a long swim in cold water unless a boat accompanies you to pick you up in case of necessity.

5. Be careful not to go too far out when there is a strong undertow; that is, a strong current below the surface of the water flowing relentlessly out to sea.

6. Always wade upstream.

RESCUE

When a person gives up the struggle in the water, the body goes down, and then because of its buoyancy it comes to the surface and some air is expelled from the lungs, making the body less buoyant. It immediately sinks again, this time a little lower, and again comes to the surface, and more air is expelled. This process may be repeated several times, until sufficient water is taken into the stomach and lungs to overcome the buoyancy of the body and it no longer appears at the surface; but the buoyancy is barely overcome, and therefore the body will float easily. This can easily be utilized in saving the drowning person by making the water carry most of the weight of the body.

To do this, place the hands on either side of the drowning person's head, and tow him floating on his back with the face above the surface of the water, while you swim on your back and keep the body away from you. Remember, if possible, to go with the current and thus save necessary strength. In some cases it may be easier and safer to grasp the drowning person by the hair instead of trying to clasp the head.

EMERGENCIES

Grips—A drowning person is always a frightened person, and is governed by a mad instinct to grab anything which subconsciously he thinks may save his life. Usually he is past any reasoning. He grabs his would-be rescuer with a death grip that is hard to break, but remember he instinctively grabs what is above the surface and will not try to grab below the shoulders.

Wrist Grip—If the drowning person grasps the rescuer's wrists, the rescuer throws both hands above his head, which forces both low in the water, and then turns the leverage of his arms against the other's thumbs and breaks the grip.

Neck Grip—To release a grip around the neck and shoulders from the front, immediately cover the mouth of the other with the palm of the hand, holding the nose between the first two fingers, and at the same time pull the other body toward you with the other hand, meanwhile treading water. Then take a full breath and apply your knee to the other's stomach quickly, thus forcing him to expel any air in his lungs and preventing him from getting more air by the hand on mouth and nostrils.

If the grip of the drowning person does not allow use of the arms, then try to raise your arms to the level of the shoulder, thus slipping his arms to the neck and leaving your own arms free to use, as described.

Back Grip—This strangle hold is perhaps the most difficult to break, and it is necessary to break it instantly if the rescuer is not also to be in the rescued class.

Grasp the wrists of the other and push sharply back with the buttocks against the abdomen of the other, and thus make room to slip suddenly out of the encircling arms.

If this is not successful, do not despair, but throw the head suddenly against the nose of the drowning person and then slip out of the grip before he recovers from his daze.

It is often necessary to dive from the surface in rescuing a drowning person, and this requires practice, and should be learned thoroughly before the necessity for saving a life is presented. Remember that to dive from the surface to a depth of more than ten feet will usually require a weight in addition to the weight of the body. Carry a stone or other heavy object in diving. Then when wishing to rise to the surface, drop it and push against the bottom with the feet. This will send the swimmer to the surface in short order.

In carrying a weight in the water, carry it low on the body, close to the waist line, leaving one hand and both feet free for swimming. Or if for any reason it is necessary to swim on the back, it leaves both feet free to use as propellers.

ARTIFICIAL RESPIRATION

If the apparently drowned person is to be saved, no time must be lost in the rescue from the water or in getting the water out of him, and breathing re-established after he is brought to land.



If there is a messenger handy send for a doctor at once, but in the meantime lose no time in attempting restoration.

The best method for getting the water out of the lungs and breathing re-established is the Schaefer Method, because it is the simplest, requiring only one operator and no equipment. It can be kept up alone for a long time.

1. Every moment is precious. Immediately lay the patient face downwards, with the arms extended above the head and the face to one side. In this position the water will run out and the tongue will fall forward by its own weight, and not give trouble by falling back and closing the entrance to the windpipe. Be sure there is nothing in the mouth, such as false teeth, gum, tobacco, etc. Do not put anything under the chest. Be sure there is no tight collar around the neck.

2. Kneel astride of the patient facing toward his head.

3. Place your hands on the small of the patient's back, with thumbs nearly touching and the hands on the spaces between the short ribs.

4. Bend slightly forward with arms rigid so that the weight of your body falls on the wrists, and makes a firm steady pressure downward on the patient while you count one, two, three, thus forcing any water and air out of the lungs.

5. Then relax the pressure very quickly, snatching the hand away, and counting one-two—the chest cavity enlarges and fresh air is drawn into the lungs.

6. Continue the alternate pressing and relaxing about twelve to fifteen times a minute, which empties and fills the lungs with fresh air approximately as often as he would do it naturally.

It may be necessary to work for an hour or two before a gasp shows the return of natural breathing. Even then the rescuer's work is not over, as it will be necessary to fill in any gaps with artificial breathing. When natural breathing is established, aid circulation by rubbing and by wrapping him in hot blankets and putting hot bottles around him, being careful that they are protected to prevent burning the patient.

If at any time it is necessary to pull the tongue forward and to hold it to prevent choking, remember to put a wedge between the teeth to prevent biting. Do not give anything liquid by mouth until the patient is conscious and can swallow readily. Aromatic Spirits of Ammonia or Spirits of Camphor may be used on a handkerchief for the patient to smell. The patient should be watched carefully for an hour or two even after he is considered out of danger.

ICE RESCUE

Prevention: Below are two rules for preventing ice accidents:

1. Do not skate or walk on thin ice.

2. Watch for air holes.

Rescue: In trying to rescue a person who has broken through the ice, always tie a rope around your own body and have this tied to some firm object on shore. Do not try to walk out to the rescue as the ice will probably break again under the weight of your body on so small an area as the size of your feet. Always get a long board, ladder, rail or limb of a tree, and either crawl out on this, which will distribute the weight of your body over a larger surface of ice, or lie flat on your stomach and crawl out, pushing the board ahead of you so that the person in the water may reach it. If you yourself break through the ice in attempting a rescue, remember that trying to pull yourself up over the edge of the ice only breaks it more. If rescuers are near it is much wiser to support yourself on the edge of the ice and wait for rescue.

After getting the person out of the water use artificial respiration if necessary and bend every effort to get the patient warm and breathing properly.

ASPHYXIATION

Prevention: Below are seven rules for preventing asphyxiation:

1. When coal stoves and furnaces are freshly filled with coal, coal gas may escape if the dampers are not properly regulated. See that all dampers in coal stoves and furnaces are correctly arranged before leaving them for any long time, as for the night.

2. Do not go to sleep in a house or room with a gas jet or gas stove turned low. The pressure in the pipes may change and the flame go out, or a breeze may blow out the flame leaving the gas leaking into the room.

3. Do not blow out a gas jet.

4. Be careful to turn off gas jet completely.



5. Report gas leaks promptly.

6. Charcoal stoves and braziers are especially dangerous from escaping gas and should not be used in sleeping rooms.

7. Do not go into unused wells or underground sewers without first lowering a lighted candle which will go out at once if the air is very impure, because of lack of oxygen to keep it burning.

Rescue: 1. Remove the patient at once to the fresh air. Gas is lighter than air, and therefore will not be found close to the floor and it will often be possible to crawl out when one would be overcome by the gas if he tried to walk out. For this reason it is sometimes best in trying to rescue anyone already unconscious from gas to tie the wrists together with a handkerchief, put his arms around your neck, and crawl out on all fours, dragging the insensible body with you, under your own body. If you attempt to walk out and carry the patient, cover your mouth and nose with a wet handkerchief, go very quickly, do not breathe until you reach the fresh air.

2. If there is a messenger handy, send for the doctor at once, but in the meantime if necessary, perform artificial respiration as outlined under the Schaefer System in the preceding paragraphs, until the patient is restored to normal breathing.

ELECTRIC SHOCK

This is caused by some part of the body coming in contact with a live electric wire. The seriousness of the shock depends on how heavy a charge of electricity the wire is carrying at the time.

The patient is usually unable to release himself from the wire. The first thing to be done, if possible, is to turn off the current by means of the switch, but if this cannot be done at once, the patient must be rescued by pulling him away from the wire.

Remember his body will easily carry the charge to yours while he is against the wire. Therefore you must "insulate" yourself—that is, put on your hands something that will not let the electricity into your body—or stand on something that will "insulate" you; for instance, rubber gloves or rubber tobacco pouches, dry silk handkerchiefs, other silk garments or newspapers used in place of gloves if necessary. Stand on a rubber mat or on dry boards, or glass, or in dire necessity dry clothes can be used to stand on. They must not be wet as then they will carry the electric current through your body and you must also be rescued instead of rescuing.

Prevention: 1. Do not touch the "third rail" of electric railways.

2. Do not catch hold of swinging wires, they may be "live wires."

3. Report broken wires to the right authorities.

Treatment:

1. Get patient loose from the current.

2. Send for the doctor.

3. Lay the patient flat on his back.

4. Loosen the clothing, and perform artificial respiration according to the Schaefer method if necessary.

5. Give first aid treatment to the burns.

FIRE ACCIDENTS

The first thought about a fire is to get it put out before it spreads any further. There are methods which will do this work effectually and Girl Scouts should learn these methods beforehand thoroughly, in order that when the emergency arises they may act quickly, coolly and effectively.

FIRE IN CLOTHING

If this happens in your own clothing, do not run for help, as the draft made by the motion of your body will only fan the flames to burn fiercely.

Grab the nearest thing that will cover you; overcoat, blanket, rug, wrap it tightly around you at the neck first to prevent flames from burning the face and lie down and roll over and over. This will smother the flames quickly. If you can get nothing to wrap around you, lie down and roll slowly over and beat the fire with your hands covered by some part of your clothing not on fire.

If the fire is in the clothing of another, wrap him in the nearest thing available, lay him on the floor and roll him over, smothering the flames as described before.

Woolen material will not catch fire as easily as cotton, therefore, if you have a chance to choose, take woolen material for smothering the flames.

RESULTS

Results of fire in the clothing are sure to be more or less serious burns.

When you have discovered the extent of the burn, if it is at all serious, send for the doctor at once, and in the meantime treat the burn as you have already learned to do in minor burns.

FIRE IN BUILDINGS

Keep cool, in order to remember what to do, and do it quickly.

Turn in a fire alarm at once. Send some one else if possible who may not know what to do to the fire. The quickest way is by telephone call, "Fire Department," and tell them the exact address of the building where the fire is. Or you may go to the nearest alarm box, smash the glass, open the door, and pull down the hook that sounds the alarm. (Generally the directions are printed on the box.) If you cannot sound the alarm alone, call upon the nearest person to help you. Wait there until the firemen arrive and direct them to the fire. When the firemen come do just as they tell you, for they know exactly what to do.

People trying to escape from a burning building often get frightened and then there is a panic. Panic kills more people than fire. Keep cool, and others will follow your example.

Never jump from a window unless the flames are so close that it is your only means of escape. If outside a burning building put mattresses and bedding piled high to break the jumper's fall and get a strong hold on a rug to catch the jumper, and let many people hold the rug.

If the fire is just beginning, it can easily be put out by smothering it with a rug or blanket; sand, ashes, salt, or a few pails of water will answer the same purpose.

Keep the doors and windows closed if possible to prevent draughts from fanning the flames to fiercer effort.

Remember this point when you go into a burning building, and leave some responsible person guarding the door, in order that it may not be left open by some one in excitement and the flames fanned beyond control.

If you need fresh air in your search for people in a burning building, open a window, put out your head and draw your lungs full of fresh air and then close the window again. In any case it is best to tie a wet handkerchief or towel over the nose and mouth while in a burning building, as this will prevent you from breathing a good deal of smoke.

In searching for persons remember always to begin at the top of the building if possible, and search every room. When on stairs keep to wall side, where air is relatively free from flames and smoke. If a room is locked, try to rouse the people by pounding and calling and then break in the door if unsuccessful in rousing them, and you suspect there is some one there.

Remember, the air within six inches from the floor is usually free from smoke, and if the smoke makes breathing too difficult, you can still accomplish your end by crawling along the floor and dragging the rescued one with you as you learned to do in gas rescue.

Form a bucket brigade from the fire to the nearest water supply; passing the filled pails from one to another rapidly, the last throwing the water on the fire and passing the empty pails back along another line to be filled again and passed on as before.

FIRES FROM KEROSENE, GASOLINE, BENZINE

Prevention.—1. Do not light a fire with kerosene.

2. Do not clean gloves or clothing with gasoline or benzine in a room with a lamp or gas jet lighted.

3. Do not try to dry clothing that has been cleaned with gasoline or benzine near a hot stove or lighted gas jet.

Extinction.—Do not use water to put out a fire of kerosene, benzine, or gasoline, as that only scatters the flames. Smother with blankets, rugs, sand, ashes, salt, or anything which is at hand and can be used; remember that woolen will not catch fire as easily as cotton.

COMMON POISON AND ANTIDOTES

Poisoning—Cases of poisoning happen most often because people do not examine the bottles before taking medicines from them.

Prevention—Disinfectants, liniments and medicines in bottles and boxes should be correctly and plainly labelled.

Bottles containing a poisonous substance should be rough outside, or with notched corks or marked with something beside the label stating that their contents are poison.

Treatment—1. Send for the doctor at once, telling him what kind of poison you think the patient has taken in order that he may bring the right antidote and the right implements to give the quickest and most effective relief.

2. Give demulcent or mucilaginous drinks, as for example, milk, raw egg, one or two tablespoonfuls of salad oil, sweet oil, or barley water—which can be obtained most readily.

3. Give something to produce vomiting, provided the lips are not burned or stained as they are with an acid or alkali. A simple but effectual emetic can be made by mixing two teaspoonfuls of salt or a tablespoon of mustard in a glass of lukewarm water. This may be repeated if necessary.

4. If the patient seems drowsy, suspect opium and keep patient awake at all costs till the doctor arrives.

5. If delirium threatens, dash cold water on the patient's head and face to try to prevent the fit from coming on.

6. When the poison taken has been acid, the antidote should be an alkali, but different poisons require different antidotes, and it would be unwise to trust to one's memory as to the proper one to take in each case. It would be well to have a list of the more common poisons and their antidotes attached to the First Aid Kit, but do not trust to the memory. If a Girl Scout does not know, and if the patient's lips are not stained or burned, give an emetic.

Bandages

Bandages form the most convenient way of keeping dressings on wounds and for making pressure when necessary. They are also used to correct some deformities, but you will not need to concern yourselves with the latter, as this is in the province of doctors.

There are three varieties of bandages which you will need to use and with which you should be familiar: the roller, triangular and four-tailed. The materials used for bandages are absorbent gauze, muslins or flannels. The kind you will use most will be gauze and muslin. The gauze is best to use in dressing wounds because it is pliable and absorbent, and muslin, if you may choose, in applying pressure, because it is firm. In an emergency there will usually be little chance to choose. Anything at hand, as underclothing, sheets, blankets, etc., may be torn into strips or triangles and used. Have the material which is used clean if possible.

The width of the roller bandage depends on the part of the body to be bandaged, from one inch for the little finger to four inches for the body. They can be rolled very well by hand with a little practice, and every Girl Scout should learn to do this or to improvise a bandage roller by running a very stiff wire through a small wooden box and then bending one end on the outside of the box like a handle.

A bandage must be rolled sufficiently tight so that the center will not fall out. By folding one end back and forth a few times to make a core, and then laying the bandaging over one's knees lengthwise of the thigh with the core uppermost, it can be rolled quite tightly and answer every purpose for emergencies.

Learn to put on all bandages smoothly and securely, but not too tightly.

Triangular Bandages—These bandages have advantages for first aid work. They can be quickly made, easily applied and are not apt to be put on too tightly even by a beginner.

The size of the piece of cloth varies with the part to be bandaged. Take a square piece of cloth (it should not be less than 34 to 38 inches), fold it diagonally from corner to corner and cut across the fold, making two bandages.

The bandage may be applied unfolded or folded into a narrow strip, called cravat bandage.

To fold the cravat bandage, the point of the triangle is brought to the middle of the diagonal side and the bandage folded lengthwise to the desired width.

The cravat bandage is convenient to use in bandaging the hand, foot, head, eyes, throat and jaw; for tying on splints; for tying around the limb in case of snake bite, and in making a tourniquet.



Always tie the bandage with a square knot to prevent slipping. Care must be used in applying the triangular bandage to have it smooth and firm, folding the loose ends into pleats evenly.

Bandage for Hand—For wound of the palm, lay cravat in straight line, place palm across it at the middle. Fold ends over the back of hand, carry around wrist and tie. Reverse the order for injury to the back of the hand.

To cover entire hand, unfold cravat, lay flat with point of triangle beyond the fingers. Fold the point of the bandage over the fingers, cross the ends, and pass around wrist and tie at the back.

Bandage for Foot—Place foot on the smooth triangle with the point extending beyond the toes several inches. Fold the point back over the instep, cross the ends, carry around the ankle and tie.

Bandage for the Head—The bandage may be used flat or as a cravat, according to the nature of the injury and the part to be bandaged.



For a cap bandage, fold over the edge of the diagonal edge, place on the head with the folded edge just above the eyes; pleat the edges hanging down over the ears into small folds so that the bandage lies smoothly; carry the ends around the head; cross at the back, and tie in a square knot in front. The cravat bandage may be used to hold on small dressings where the whole head does not need to be covered.

For the eyes, jaw and throat the triangular bandage is used by folding smoothly into a cravat and tying securely over the part to be covered.

Arm Sling.—The triangular bandage makes the best arm sling to support the forearm or for supporting injuries to the elbow or shoulder.

An arm sling is firmer and more satisfactory if the triangle is double; that is, simply fold over the square diagonally, but do not cut it along the fold. An arm sling will need to be about a yard square before folding.

To adjust the arm sling, put one end over the shoulder on the uninjured side; slip the point of the triangle under the injured arm, so that it will extend beyond the elbow a few inches; then take the end of the bandage over the arm, carry around the back of the neck on the injured side, meeting the other end; and tie securely. To prevent slipping, pin the point of the bandage around the arm just above the elbow.

A temporary sling can be made by pinning the sleeve of the injured arm to the dress or coat in such a way as to support the arm.

The Four-tailed Bandage—This bandage is useful for bandaging the head, and especially in fracture of the jaw. Use a piece of cloth about six or eight inches wide and a yard long. Cut each end into two equal parts, leaving about three or four inches in the middle uncut.



When the bandage is applied, the split ends are crossed so that they may be tied over different parts of the head and thus hold the bandage more securely in place. For instance, in the jaw bandage the uncut middle part is placed over and under the chin, the ends crossed, and two ends tied at the back of the neck and two over the top of the head.

Roller Bandages—Roller bandages are a little more difficult to put on so that they will stay on, and at the same time be smooth and have a uniform pressure on the part of the body bandaged. This last point is most important.

Rules for applying roller bandages:

1. Lay external surface of bandage against the part to be bandaged, holding the roll in the right hand, unless you are left-handed, unrolling it as a roll of carpet unrolls to show you a pattern in the shops.

2. Hold the loose end with the left hand and catch it with two or three turns of the bandage before beginning to put on the bandage. Never have more than four or five inches of the bandage unrolled at once.

3. Be careful to have the same pressure from every turn of the bandage. This is most important if the bandage is to stay on and be comfortable and not interfere with the circulation of the blood. Judgment of the pressure is only acquired by practice, and therefore you should practice enough to acquire this before the real emergency happens.

4. Do not bandage too tightly. Blueness of the skin above or below the bandage always means the bandage must be loosened. Remember in applying a bandage immediately after an injury that considerable swelling may occur later, and apply your bandage more loosely than if bandaging after the swelling has gone down. Always loosen a bandage that is tight enough to cause pain or blueness.

5. Bandage from below upward. That is, from the tip of a finger or toe toward the hand or foot. From the hand or foot toward the shoulder or groin. This is in the general direction of the return of the circulation.

6. Bandage over a splint and not under it.

7. Bandage arms, legs, fingers, etc., in the position the patient is to keep the part in when the bandaging is completed. For instance, bend the elbow to a right angle before putting on the arm bandage. This will be more comfortable for the patient, allowing him to carry the arm easily in a sling and also permit him to use the hand to some extent if the nature of the injury will permit. In bandaging a leg both above and below the knee, the bandage must be put on with a view to the necessary bending of the knee in walking and sitting, if the patient is expected to use the leg.

8. Never apply a wet bandage, as you cannot judge of just how much pressure will be exerted when the bandage dries, because of the shrinkage of cloth with drying; much greater in some cloth than in others.

Kinds of roller bandages:

1. Circular for parts uniform in size, as the body.

2. Spiral for conical surfaces, as fingers or toes.

3. Reverse for more conical surfaces, as arms and legs.

Circular Bandages—Any part of the body which is of uniform size may be covered with a circular bandage. Each turn covers about two-thirds of the previous turn. This holds each turn firmly and prevents slipping and exposing the dressing or wound underneath. Bandage in general direction of the return of the blood to the heart. Fasten the bandage with a strip of adhesive plaster or safety pin. If there is possibility of restlessness or much activity on the part of the patient, it is best to run several narrow strips of adhesive plaster along the whole width of the bandage when finished to prevent possible slipping of the turns of the bandage when the muscles move under it with the activity of the patient. This is especially true of a body bandage.

Spiral Bandage—A conical part, if not too conical, may be covered with a spiral bandage. Each turn ascends at a slight angle, with one edge of the bandage a little tighter than the other. In putting on this kind of bandage it is necessary to learn to have the tight edges all of a uniform pressure and each turn overlap the turn below in such a way that these tight edges make the uniform pressure without regard to the upper edge underneath, which is covered in each turn by the tighter edge of the turn above it.

Reverse Bandages—The reverse bandage is a modification of the spiral one, in order to cover the gapping between spirals which occurs when the surface is very conical, as, for instance, on the leg.

In putting on this bandage the loose end is caught by two or three turns first as in other bandages. Then start to make a spiral turn, but at the mid point of the front of the part being bandaged place the thumb of the left hand, and fold the bandage down so that it lies smoothly and continue the turn around to that same point. Repeat the process with each turn. (See illustration.) Each turn covers two-thirds of the one below in order to hold firmly. The pressure must be uniform when the bandage is finished. Fasten the ends as described under circular bandages, or divide the end of the bandage into two parts for several inches—long enough to wind around the part bandaged. Tie a single knot at the base to prevent further dividing, and wrap the ends around the part in different directions; tie in a hard knot to hold firmly.

Bandaging Fingers and Toes—In bandaging fingers and toes it is usually best to bandage the whole of the injured member. Cover the end of the finger, for instance, by passing the end of the half inch or one inch bandage several times the whole length of the finger, over the end and to the base of the other side. Hold this in place with one hand, start the spiral at the end of the finger, and bandage smoothly toward the hand. The spiral or the reverse spiral may be used.

Bandaging Two or More Fingers or Toes—It is sometimes necessary to bandage two or more fingers, for instance, at once, as in case of a burn, where it is necessary always to have the burned fingers separated while healing to prevent the raw places from growing together.



Pass a finger bandage twice around the wrist and pass obliquely to the base of the thumb. Carry to the end of the thumb and bandage as described above. When the thumb is bandaged, carry the bandage back to the wrist; pass around the wrist in one or two circular turns, and carry the bandage to the first finger and bandage as before. Repeat this until all the fingers are bandaged. Carry the bandage back to the wrist, after the last finger you wish to bandage is done; make one or two turns around the wrist and fasten.



In bandaging the foot, carry the bandage to the ankle to make secure and hold in place.

Bandaging Arms and Legs—The reverse spiral is usually best for bandaging these, because of the conical shape. Practice alone can teach you to put this on smoothly, firmly, not too tightly, and at the same time quickly. A reverse bandage will not stay in place on the leg of the person walking around unless pinned in many places or stuck by sizing in the cloth (which has been wet), plaster, etc. Only a figure eight caught over the top of the calf, in each alternate loop, will do so.

The Figure Eight Bandage—The figure eight is a modification of the spiral used in bandaging over joints in such a way as to permit some motion and at the same time keep the bandage firm and in place.

The bandage is carried first below and then above the joint; then below and then above, the turns overlapping the usual two-thirds of the width of the bandage, leaving the joint free until the last. Then it may be covered with two or three circular turns of the bandage. This admits of considerable motion without disturbing the bandage to any extent.

The National Red Cross and Girl Scout Instruction in First Aid



By special arrangement with the National Red Cross, it is possible for a Girl Scout completing satisfactorily the requirements for the First Aid Proficiency Badge to secure with slight additional work the Red Cross certificate in First Aid. Or the course may be taken entirely under Red Cross auspices, though arranged by Scout officials, in which case the Scout may receive both the Proficiency Badge and the Red Cross certificate. The conditions of this co-operation between the Girl Scouts and the National Red Cross are as follows:

Classes are to be organized with not less than four or more than twenty-five in a class. The best size is ten to fifteen. Scouts must be at least sixteen years of age to be admitted to these classes.

The instructor must be a physician appointed by the Chairman of the First Aid Committee of the local Chapter of the Red Cross. He or she may be supplied upon request by the Chapter, or chosen by the class and the name submitted to the Chapter for appointment.

The Red Cross class roll must be sent in to the local Chapter early in the course.

A Secretary to handle the records should be chosen, and where the class is made up of Scouts, the officials should be preferably a Scout Captain or Scout Official.

The examiner must be a physician appointed by the local Red Cross Chapter and is preferably some one other than the instructor, but this is not necessary. Like the instructor, the examiner may be supplied by the Chapter or chosen by the class.

The Red Cross examination roll, which may be obtained from the Chapter, should be used in giving examinations and then returned to the Chapter, who will issue the certificates. Follow the directions on the roll carefully.

If a Scout holds a First Aid Proficiency Badge she may complete the course in seven and one-half hours. If she does not hold a Proficiency Badge in First Aid then fifteen hours will be required. A Girl Scout holding a Proficiency Badge in First Aid and taking a school course held under Red Cross auspices which she passes with a mark of at least seventy-five per cent, can, when the school principal certifies to this, get the Red Cross certificate without further examination by applying to the local Red Cross Chapter.

Advanced Courses

Advanced courses are open to those who have the Red Cross certificate. There must be an interval of at least six months after the elementary course before an advanced course can be taken, and the same interval between repetitions of it. The course of instruction is seven and one-half hours, mainly practical demonstrations. A Red Cross medal is given on completion of this course. Each time it is repeated, up to three times, a bar (engraved with year) is given to be added to the medal.

Fees

A fee of fifty cents is required for the elementary course. The local Red Cross Chapter has the right to reduce this fee.

The fee for the advanced course is one dollar, which covers the cost of certificate, examination and medal. The fee for bar and engraving is fifty cents. These fees cannot be reduced.

These fees cover the cost to the Red Cross of postage, certificates, medals, bars, and so forth, but do not cover that of instructor, examiner, or classroom supplies, which the Red Cross requires the class to take care of.

Information

Where there is no local Girl Scout organization refer to the local Red Cross Chapter; or if there is none, either to the Girl Scout National Headquarters, 189 Lexington Avenue, New York, N. Y., or to the Department of First Aid, American Red Cross National Headquarters, Washington, D. C.

4. THE HOME NURSE

The Girl Scout who has earned the Home Nurse Badge may be of great help where there is illness. But, she should remember that only such people as doctors and trained nurses who have knowledge and skill gained by special training and thorough practice are fitted to care properly for those who are very ill.

If the Scout with the badge keeps her head and shows herself steady, reliable and willing, when called upon for help in illness or emergencies, she proves herself a true Scout who is living up to the Scout motto of "BE PREPARED."

To earn the badge she should know:

How to keep the sick room clean and comfortable.

How to make a bed properly.

How to prepare for and help a sick person in taking a bath.

How to make a sick person comfortable in bed, changing position, etc.

How to take temperature, pulse and respiration.

How to prepare and serve simple, nourishing food for the sick.

How to feed a helpless person.

How to prepare and use simple remedies for slight ailments.

How to occupy and amuse the sick.

When helping about the sick, the Scout should wear a wash dress or an apron which covers her dress. She should be very neat and clean. She should wash her hands frequently, always before her own meals, and after coming into contact with the sick person and after handling utensils, dishes, linen, etc., used in the sick room. Great cleanliness is necessary not only for her own protection but to prevent illness spreading.

She should move quickly and quietly, but without bustle or hurry, taking care not to let things fall, not to bump against the furniture, not to jar the bed, not to slam doors, in fact not to make any unnecessary noises, as sick people are not only disturbed but may be made worse by noises and confusion. If a door is squeaky the hinges should be oiled. Too much talking, loud talking and whispering are to be avoided. Only cheerful and pleasant subjects should be talked of, never illnesses either that of the patient nor of others.

The best nursing aims not only to bring relief and comfort to those already sick, but to guard against spreading sickness.

We know, now, that many diseases are spread by means of germs which are carried from person to person by various means, such as air, water, milk, and other food; discharges from the mouth, nose, bowels, bladder, wounds; clothing; the hands; the breath, and so forth.

It has been found that great heat, intense cold, sunshine and some powerful drugs called disinfectants kill germs. Germs thrive and multiply in dirt, dampness and darkness. That is why it is important to have fresh air, sunshine and cleanliness in order to keep well, and to help in curing those who get sick.

The Room, Its Order and Arrangement

The hangings and furniture of a sick room should be of a kind that can be washed and easily kept clean. Plain wooden furniture is better than upholstered furniture which collects and holds the dust. If there is a rocking chair it should be for the use of the sick person only. Seeing and hearing other people rock may be very disturbing.

If carpets are movable, so much the better, as they can be taken out to be cleaned.

The room should be bright and attractive. Sick people like flowers and pretty things, but the flowers should not have a strong perfume, and there should not be too many ornaments around to collect dust and to take up too much room. Flowers should be taken out of the room every night and the water changed before being returned to the room in the morning. Never have faded flowers around.

The room should be kept neat—a place for everything and everything in its place.

Neatness and attractiveness are not only pleasing to the sick person and those who come into the room but may really make the sick person feel better.

Medicines should not be kept in sight. All dishes and utensils not in use should be taken away and should be washed immediately after use.

Ventilating and Lighting the Room

The room of a sick person should be so situated that it will get plenty of sunlight and be easily aired. A room that has two or more windows can be better ventilated than a room with only one. When there is only one window, it should be opened both top and bottom. If there is not a screen, one can be made by hanging a shawl or a blanket over a clothes horse or a high-backed chair, or over a line stretched across the lower part of the window. A fire place or a stove keeps the air circulating—the air being constantly drawn up the chimney—and so helps in ventilating a room.

When "airing" the room great care must be taken to keep the sick person free from draughts.

Unless special orders have been given to the contrary there should be plenty of sunshine let in. The eyes of the sick person should be protected from the glare by a screen.

If possible there should be a thermometer in the room. The proper heat is between 65 and 70 degrees. If the temperature of the room is as high as 70 degrees and the sick person is cold, it is better to give her a hot water bag and to put on more covers than to shut the windows, thus keeping out the fresh air. Cool air acts as a tonic for the sick.

Cleaning the Room

The carpet should be gone over every day to remove the surface dust. Use the carpet sweeper, being careful not to knock the furniture nor to jar the bed. Raise as little dust and make as little noise as possible. Torn-up wet paper scattered on a small part of the carpet at a time and lightly brushed up into a dustpan with a whisk broom, or a broom, cleans the carpet very well without raising dust.

If the carpet cannot be taken out to be swept or beaten but requires thorough sweeping, an umbrella with a sheet over it may be hoisted over the head of the sick person to keep the dust from her nose and nostrils. The bare parts of the floor should be gone over with a damp duster or a damp mop.

The dusting should be done with a damp or oiled duster also, so that the dust may not be scattered. A basin of soapy water should be at hand and the duster washed in it frequently while dusting, so that the dust collected on it from one surface will not be carried to another. While dusting special attention should be paid to the doorknobs and that part of the door around them.

When the dusting is finished the dusters should be thoroughly washed and scalded and hung out of doors to dry.

The Bed

A metal bedstead is better than a wooden one, as wood holds odors and moisture, and is apt to have more cracks and crevices for germs or bugs to lodge in. It should be white, for then it shows when it needs cleaning and bed bugs keep away from white surfaces which show them up easily.

If possible, have the bed in a part of the room, where the drafts will not strike the patient every time a door or window is opened, and where the light does not shine in the eyes. If it can be placed so that the patient can see from the window so much the better.

To Make an Unoccupied Bed

Remove pillows and bedclothes, one at a time, being careful not to let corners drag on the floor, and put to air. Turn the mattress over from end to end one day, and from side to side next day. If the patient does not have to return to bed at once leave to air for at least half an hour.

An old blanket, old spread or a quilted pad, spread over the mattress not only protects the mattress but prevents the sheets from wearing out, and may make the bed more comfortable. These should be kept clean.

The bed for a sick person is frequently made with a rubber sheet and a draw sheet. The draw sheet is so called because its proper use is to be drawn through under the patient without greatly disturbing her and give her a cool fresh place to lie on. Therefore it should be long enough to tuck in sufficiently under one side to allow of this being done. An ordinary sheet folded in two from top to bottom and placed with folded edge toward the head of the bed may be used. It should entirely cover the rubber sheet, which is usually put on between the bottom and the draw sheet.



When the mattress is sufficiently aired, put on the protective covering. Over this spread the lower sheet so that the middle fold of the sheet lies up and down the centre of the mattress from head to foot. Keep perfectly straight. The sheet should be long enough to have at least fourteen inches over at ends and sides to tuck in. Tuck ends under mattress at head and foot drawing tightly so that it will be smooth and firm. Now tuck under at one side, folding neatly at corners, so that they will be mitred when finished. If there is no rubber nor draw sheet to put on, go to the other side of the bed and tuck in firmly at corners. Then, pulling the middle of the sheet very tightly with one hand, push the mattress with the other and tuck the sheet under. This under sheet should be very smooth without a wrinkle in it. If it is not long enough to tuck in well at both head and foot, leave plenty at the head to tuck in securely and tuck in at the sides tightly rather than risk having it come loose at the head. Be sure, however, that the mattress is entirely covered.

When Rubber and Draw Sheets Are Used

Before going around to the other side, lay the rubber sheet over the bed, so that the top edge will be well above where the lower edge of the pillow will come. Put the draw sheet over it. Tuck both well under the mattress on that side. Then, go to the other side and tuck in the corners of the lower sheet as directed, then stretching draw, rubber, and under sheet very tightly, tuck in separately.

Next spread the upper sheet, wrong side up, leaving as much at the head to turn back over the blankets as you left in the under sheet to tuck in. Have the middle fold over that of the lower sheet. Spread the blankets so that their upper edges will be even with the upper edge of the mattress. If the blankets are not long enough to reach as far up as they should, and yet tuck under firmly at the foot, place the lower one as directed, and the upper one so that there will be enough to tuck under at the foot, and hold the others in place. Tuck in all at once the foot and lower corners, mitring the corners as you did those of the lower sheet. Pull and straighten the sheet at the top and turn back smoothly over the blankets. If the bed is not to be occupied right away, tuck in both sides, stretching well so that it will have a smooth surface. Put on the spread, having the top edge even with the top of the covers. Tuck in neatly at foot and lower corners, letting the sides hang. Shake and beat the pillows thoroughly, make smooth and even, and put in place.

To Change the Under Sheet When the Patient Is in Bed

Loosen the bedclothes, without jarring the bed. Take off covers one at a time, until only one blanket and sheet remain. (If the patient feels cold, leave as many blankets as necessary to keep her warm.) Holding blankets with one hand or having patient hold it by the top, draw off the upper sheet, being careful not to uncover the patient. Remove the pillows. Have the patient as near the side of the bed as is safe, on her side, and facing the side on which she is lying. Roll the under sheets on the side of the bed close to the patient's back, making them as flat as possible. Pleat about half of the fresh under sheet lengthwise, and place close to the soiled sheets. Tuck in the other half, at the head, foot and side, draw the rubber sheet back over this fresh sheet, arrange the fresh draw sheet in place, tuck both in at that side and roll the free part close up to the patient's back. Now lift the patient's feet over the roll of fresh and soiled linen to the freshly made part, then have her roll her body over that side. Going to the other side of the bed, remove all the soiled linen and tuck the fresh sheets in, pulling tightly, being sure that there are no wrinkles under the patient. All the time keep the patient well covered. Now, spread the upper sheet and blankets over the covering the patient has had on while the lower sheets were being changed and, having the patient hold the coverings you have just put on, draw off the others, just as you took off the top sheet at first. Finish making the bed as you would an unoccupied one.

If the Bed Is to Be Occupied at Once

If the bed is to be occupied at once the coverings should be tucked in only at foot, corners and one side, then turned back diagonally from the head to foot.

The bed clothes should never be drawn too tightly over a person in bed, or they may irritate the skin, especially at the knees and toes. Bed sores may be started in this way. Perhaps the commonest cause of bedsores is from wrinkles in the under sheets. If the spread is heavy it should not be used over a patient. Use a sheet instead to protect the blankets.

Bathing

Bathing is more important for the sick than for the well. It not only keeps the skin clean and in condition to do its work, but it is soothing to the nerves, makes the sick person rest better and is refreshing.

If the room is the right temperature and the bath is carefully taken there is no danger of a sick person taking cold. On the other hand bathing helps to keep people in condition to avoid taking colds. (See Red Cross Text Book on Home Hygiene and Care of the Sick, page 156.)

When a patient is very sick or helpless, the bath should be given by someone who is able to do it deftly and quickly, with the least exertion to the patient.

Very often, however, a person in bed is quite able to bathe herself, with a little help, if the necessary things are brought to her.

To Prepare For a Bath in Bed

Have the room warm and free from draughts. A good temperature is 70 degrees. An old person or a baby may have it warmer.

Bring into the room everything needed. This will include:

An extra blanket to wrap around the sick person.

Two or more bath towels.

Two wash cloths—one for the face and another for the rest of the body.

Soap—Ivory or castile are good.

Pitcher of good hot water, and slop jar.

Alcohol and toilet powder if you have it.

Nail file and scissors.

Comb and brush.

Clean bed linen and nightgown. In cold weather these may be hung near the fire or radiator to warm.

A basin of water of a temperature that the sick person finds comfortable.

When everything is ready the Scout can help by loosening the bedclothes, arranging the extra blanket, removing the nightgown, and in holding the basin and towels, in changing the water or in any way that will make the bath easier for the sick person, perhaps washing the feet and back, being careful to keep all the rest of the body covered and warm, and in protecting the bed by bath towels spread under the part being washed. When doing this the wash cloth should not be so wet that it will drip and wet the bed. It should be held so that the corners do not touch against the bedclothes. There should not be too much soap used as it makes the skin feel sticky. Every part should be rinsed and dried thoroughly. Warm towels are a great help in this.

When the bath is finished alcohol or witch hazel may be used to rub the parts where there is most pressure as the back, shoulder blades, hips, buttocks, elbows, knees and ankles. This not only gives comfort but it prevents bedsores.

If a sick person gets a bath, so that it does not disturb nor tire her nor make her chilly she will usually enjoy it. By getting everything ready, by helping where needed, and by clearing up nicely the Girl Scout may make the bath a pleasure instead of something to be dreaded.

Sometimes sick people are able to go to the bathroom to take their own baths, if everything is gotten ready for them beforehand, so that they will not get tired doing so. People who are not well should never be allowed to lock themselves in the bathroom alone.

Getting Ready a Tub Bath

The bathroom should be well aired but warm. The water in the bath tub helps to warm it up. A bath towel or bath mat should be spread beside the tub on the floor and a chair with a blanket and a bath towel on it for the person to sit on while she is drying herself. The water should be about 105 degrees or a temperature that the person finds comfortable. Always let a patient try it herself with her hand and arm before getting in. Five to ten minutes is long enough to stay in the water. The towels should be within easy reach and the bathrobe, night gown and slippers placed ready to put on.

The bed should be put to air and left as long as possible, but if the patient has to get back in it immediately after her bath, it should be made—care being taken that it is warm enough. If necessary put in hot water bags and spread a blanket over the under sheet to wrap around her if she needs it. People chill easily after a bath if they are exposed to sudden cold.

Foot Baths

Foot baths are often used in the home as remedies for colds, headaches, sleeplessness and to give relief at the monthly period.

If there is not a regular foot tub a pail that is large enough to put the foot in is better than a basin as it lets the water come up around the ankles. A person may sit in a chair or on the side of the bed. Have tub about half full of water and at first of a heat that feels comfortable, putting more hot water in from time to time, until it is as hot as it can be stood. When adding hot water the feet should be away from the part of the tub where the water is poured in, and it should be added slowly to prevent possibility of burning. A person getting a foot bath should be kept very warm. Wrap a blanket around the knees so that the legs will be protected front and back. After fifteen or twenty minutes the feet should be removed from the water and dried without rubbing. They should be kept well covered for an hour or more. No one should go out immediately after a foot bath.

If mustard is to be added, mix it first in a cup and mix it gradually so that it does not lump. Two tablespoonfuls of mustard to a foot bath is about enough.

Changing of position, and supporting different parts of the body, give both rest and comfort to anyone in bed. This may be done by turning a patient and by the proper arrangement of pillows and other supports.

To turn a patient toward you place one hand over her shoulder and the other hand over her hip and draw toward you. Bend her knees, go to the other side of the bed, put both hands under her hips and draw toward you. Place a pillow lengthwise at her back, from her shoulder to waist for support.

A pillow, placed under or between the knees, often gives much relief and comfort. Small air pillows that can be placed under or against the small of the back relieve strain and rest the muscles. Anyone lying on her back will be rested by arranging pillows lengthwise at the sides to support arms. Rubber rings and air cushions are also used to relieve pressure and give support. They should always be covered, using towel or pillow case, if they have not their own fitted covers.

Rings of any size may be made of cotton wound with bandage. These are frequently needed under the heels, particularly for a patient lying on her back.



Sitting Up in Bed

When a patient is allowed to sit up in bed and a bed-rest is not available a straight chair placed bottom-up behind the patient makes a good support for the pillows. If there is no other support, at least six pillows are needed to make a patient comfortable. The pillows should be so arranged that the head is not thrown forward and that there is proper support for the back, and the arms.