104 Injury, 11,104-109 Printed in Great Britain

Aid, first and foremost: a brief outline history of the St John Ambulance Association and Brigade

lan Fletcher Assistant Surgeon-in-Chief, St John Ambulance Brigade

EARLY HISTORY THE English Tongue (or Langue) of the Order of St John of Jerusalem was re-established in ! 831, almost 300 years after its suppression by Henry VIII. So, once again, voluntary work was under- taken for those in need and from that time on the charitable work of the Order in the United King- dom grew rapidly.

Between the years 1863 and 1869 three Red Cross conventions were held in different parts of Europe to which representatives of 14 countries were invited. The first of these gatherings was in Geneva where it was agreed that the inter- national emblem should be a red cross on a white background (the Swiss flag with colours reversed). These conventions then became known as the International Red Cross Confer- ences and following this decision the Order of St John was designated the Red Cross Society of Great Britain. Our representative at the three conferences was a man named John Furley.

In 1870 the Franco-Prussian War began and within one month of its declaration that dynamic young man John Furley had enlisted the aid of Col. Lloyd Lindsay, VC and Dr Thomas Longmore (professor of military surgery). These three men founded the British National Society for Aid to Sick and Wounded, the members of which were mostly in the Order of St John.

Throughout the war Furley worked with a Dr William MacCormac at the Anglo-American ambulance unit and hospital. Later, as Sir William MacCormac, this doctor became one of

the original two brigade surgeons and in 1896 was appointed the first medical officer-in-chief of the St John Ambulance Brigade.

Experience gained by army surgeons in the treatment of war casualties resulted in the Order establishing an ambulance department in 1875, the idea being to train civilians in ambulance work. The first superintendent was Surgeon- Major Manley, VC.

About this time Surgeon-Major Peter Shepherd, an obscure young doctor who had dealt with war casualties, became very con- cerned about the way injuries were being treated in the Staffordshire potteries. He therefore started an ambulance service, first in Burslem in 1873 and then in Wolverhampton in the follow- ing year. Each was equipped with one triangular bandage, one stretcher and a wheeled litter from France. It may be of interest to know that the triangular bandage was invented by a Dr Mayor of Lausanne in 1831 and was later popularized by Prof. Esmarch of Kiel. The 'litter' was a stretcher on wheels and many were used on the battlefield.

John Furley re-designed the original litter and a major innovation was the lowering of the axle by cranking it through two right angles. This permitted the rear bearer to step over the axle and walk away with the stretcher instead of lift- ing it sideways over the high projecting wheels. So impressive was the modification that the new vehicle (now known as the St John Ambulance Litter) won a silver medal at the Brussels Inter- national Exhibition of 1877. One of these litters

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and a much earlier Prussian Army type are housed in the Historical Museum at Bow Street Police Station in London. Another is in the Royal Mews at Buckingham Palace.

John Furley requested permission to address the General Assembly of the,Order of St John on 25 June 1877 (St John's Day). The paper he read was entitled: 'The proper sphere of volunteer societies for the relief of sick and wounded soldiers in war'. An extract from this paper is of historical interest and reads as follows:

Besides intelligent directing power and woman's gentle helpfulness, which is so beneficial in the sick room, strong arms to carry stretchers and ready hands to improvize and apply splints and bandages, we must also look for that which is never sought in vain, I mean the invaluable aid of members of the medical profession--without this our efforts would be useless, but with physicians and surgeons to advise and instruct us I have no hesitation in predicting that we shall soon possess an organization the advantages of which will not only be spread over the whole Kingdom but--if occasion should arise---will be made available by Government to supply the Army hospital establish- ment. Such an organization as that, I have slightly sketched out;

This 'slight sketch' formed the origin of the St John Ambulance Association which was offici- ally inaugurated just two weeks later on 10 July 1877. An extract of the annual report of the Order, published the following year, is of interest:

The revival of the hospitaller work of the Order on a somewhat extended scale and under the supervision of a central ambulance committee, composed exclusively of its members, was decided upon at the General Assembly of 1877. The success which has attended this revival has been as signal as it has been rapid.

Within a few months twelve centres had opened, the first being at Woolwich where Peter Shepherd was one of the medical lecturers. This young army doctor was born in Aberdeen and just a year after the St John Ambulance Association was formed he was unexpectedly ordered to the Zulu War leaving unfinished a manuscript he was preparing for the St John Ambulance Association to be completed by a fellow Aberdonian, Dr Mitchell Bruce, a physician at Charing Cross Hospital. At this time Dr Bruce was in lodgings with a young surgeon, James Cantlie, and it was he who ultimately completed the work, a Handbook Describing Aids for Cases of Injuries or Sudden Illness, and published it under Shepherd's name in 1878. The preface read as follows:

This brief manual is simply intended for non- professional readers. There is no attempt made to popularize medicine or surgery; the object is to furnish a few plain rules which may enable anyone to act in case of injury or sudden illness, pending the arrival of professional help.

Regrettably, Peter Shepherd never saw the book as he was killed a few weeks later while try- ing to save the life of a comrade at Isandhlwana.

Within the next three years 28 000 copies of the handbook were sold. More centres were opened. First aid was taught in the coalmines, on the railways and in the iron industries of Middlesbrough and Cleveland. Before long the police forces were receiving courses of instruc- tion.

The term first aid was a result of a blending of 'first t reatment ' and 'nat ional aid ' (the shortened name given to the National Society for Aid to Sick and Wounded). The term was first mentioned in the records of the Association in July 1879.

What are now known as 'divisions' in the St John Ambulance Brigade were originally called 'corps ' and the first one was established at Margate but, owing to a difference of opinion, was never officially enrolled. Subsequently, the corps formed in Ashford, Kent, on 4 Apri l 1879 became the senior one.

The next important date in our history was 31 March 1887 when 24 eminent physicians and surgeons met representatives of the St John Ambulance Association. The latter included John Furley (director of the Ambulance Department), Sir Edmund Lechmere (chairman of the Association) and Wil l iam J. Church Brasier (superintendent, Invalid Transport Corps of the Association). Also present were two medical pioneers who subsequently became the first brigade surgeons, they were Sir Wil l iam MacCormac and Dr Sam Osborn. The subject of the discussion was 'A proper system of transport of invalids in London' , and as a result it was decided that all the ambulance corps of the Association should be banded together as a brigade ' . . . a s a civilian organization for civilian needs and as army and navy reserves'.

The St John Ambulance Brigade was thus formally inaugurated in June of that year and the first public duty was performed at the Golden Jubilee celebrations. Members of the Brigade, however, had to stand behind the crowds. It was not until the Diamond Jubilee, ten years later, that they were permitted to take their place alongside the police and line the route. In those early days the Brigade did not

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Fig. 1. The badge of the Order of St John.

have a distinctive uniform but personnel wore the Highland-type dress of the Association, complete with glengarry!

The director of the Ambulance Department was put in charge of the Brigade until a commissioner was appointed in 1893. The responsibility and general running of individual corps was given to interested doctors. These were styled honorary surgeons and the first to be appointed to London was Dr Sam Osborn who joined the No. 1 (St John's Gate) corps in June 1887.

The Brigade went from strength to strength and in 1888 Queen Victoria granted the Order of St John its first royal charter and appointed herself Sovereign Head. (Subsequently there were three more royal charters in 1926, 1936 and 1955 with four supplementary royal charters in the years 1907, 1958, 1970 and 1974.)

The Order of St John has both armorial bearings and a badge. The former is a plain white cross on a red ground augmented with the royal crest in the first quarter (since 1926). The badge, which members of the Association and Brigade may wear, is an eight-pointed white cross often referred to as a Maltese Cross. In 1888 the lion and unicorn, from the royal arms, were offxcially added with the animals standing on the lower three arms of the cross (Fig. I ).

The present day badge is usually depicted within a broad circle containing the words 'St John Ambulance ' , but originally the 'circle' was a garter with its buckle at the base.

Fig. 2. The service medal ofthe Order of St John.

Following the formation of the Brigade in England, centres and corps were set up overseas and the first of these was at Dunedin in New Zealand in 1892; this was closely followed by one in South Africa.

Of many letters which appeared in the news- papers of the day concerning first aid, two may be of interest. The first appeared in the North Staron 24 May 1887:

Today, a woman, Mrs Lucas of Cobden Street, was seized with an attack of apoplexy in Park Gate. She was a good deal excited in her manner and with her hair hanging down presented the appearance of one labouring under drink. Police Constable Buckle at once recognized the true nature of the attack, carefully and gently lifted her up, called a cab at once and as I was passing drew my attention to the poor woman. He subsequently saw her home when I attended her. This is another case of many others indicating the great utility and public benefit derived from the instruction received under the St John Ambulance Association. PC Buckle, I understand, has lately taken lessons in connection with the branch at Darlington and it shows that he has not by any means been an indifferent pupil. I have seen the day when such a case would have been very differently treated by a policeman as one of drunkenness.

The second extract comes from the Daily Telegraph of 6 July 1887. A correspondent writes:

A little boy, about 4 years of age, whilst playing in a field at Banstead today, 4 July, had his foot cut offby a mowing machine. Fortunately, a lady named Freeman on whose farm the accident occurred, who had attended ambulance lectures, improvized a tourniquet with a stone and a handkerchief and arrested the bleed- ing. She was much complimented by the medical men when they arrived, on the skill which she had dis- played, as they think her promptness saved the child's life.

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Thousands of people all over the world became engaged in voluntary ambulance work and in 1895 it was decided to authorize a service medal and this was finally instituted some three years later (Fig. 2). It is sometimes, but erroneously, referred to as the Long Service Medal but its correct title is the Service Medal of the Order of St John and it is not just a Brigade award. It is unique inasmuch as it is the only British medal currently awarded portraying the head of Queen Victoria. The original bust was sculptured by her daughter, Princess Louise. Other medals were also authorized from time to time and the various railway companies had their own designs, most of them embodying the badge of the Order. There were at one time some 18 or 19 of these railway badges but nearly all have been discontinued.

T R A I N I N G Quite large training classes were held in the early days of the Association, but the second edition of the textbook (known as First Aid to the Injured) stated quite categorically that: 'mixed classes of men and women are on no account permitted.' The fifth lecture outlined in the book was divided into:

1. Males only a, The improvized method of lifting and

carrying the sick or injured. b, Methods of lifting and carrying the sick or

injured on stretchers. c, The conveyance of such by rail or in

country carts. 2. Females only a, Hints on nursing. b, Preparing the patient for bed and placing

him thereon. Administering food, medicine, making and applying poultices of bread, linseed, mustard and fomentations.

Dr Cantlie (later to become Sir James Cantlie), and another young doctor, Corbet Fletcher, lectured extensively during the early 1900s and one of the main centres was at the Regent Street Polytechnic in London. In those days there was no casualty simulation as we know it today. The casualties just stated what was wrong with them or they had a label tied to them indicating the diagnosis and they were duly treated. In spite of the lack of realism which prevailed, the first competition ever staged was at King's Cross Station in 1899 where a rail disaster was arranged and Dr Sam Osborn was one of the judges. He was then chief surgeon for the metropolis (No. 1 District) and he will be remembered for his Challenge Shield, presented

in 1900, 'for annual competition in methods of improvization'.

Later on, Dr Corbet Fletcher endeavoured to introduce realism and good scenery, particularly between the years 1923 and 1926. In the latter year he arranged for the Chiswick Scenic Studios to stage the Dewar and Perrott Shield competitions.

Corbet Fletcher was a great Brigade man and eventually became the surgeon-in-chief. The author (who is no relation) was privileged to serve under him first as a private in the Brigade and later as a divisional surgeon in the London District. That was well over thirty years ago and at that time the senior brigade officer was known as the chief commissioner, the late Sir Otto Lund being the first to hold the appointment of commissioner-in-chief.

THE F I R S T W O R L D W A R At the beginning of the First World War it was decided to set up a joint war committee com- posed of eight members representing the Order of St John and eight members representing the British Red Cross Society. The first chairman was Sir Arthur Stanley, MP (BRCS) while the vice-chairman was Col. Sir Herbert Perrott, the Bailiff of Egle (of the Order) and it was his wife who, when lady superintendent-in-chief, pre- sented the well known Perrott Shield for annual competition in 1921. Sir Herbert Perrott was also the chief secretary of the Association at its inception in 1877.

During the First World War we were part of the joint voluntary aid committee and were responsible for setting up 66 St John Auxiliary hospitals, which accounted for some 3000 patients, the one at Stockport being the largest voluntary hospital in England. The St John Hospital at Etaples, with 520 beds, was con- sidered to be the best equipped hospital in France although, tragically, it was almost completely destroyed, with considerable loss of life, by two raids in May 1918. After the war the Order and the British Red Cross Society formed a joint council 'to coordinate the activities of the two bodies in peacetime'. There was an Act of Parliament in 1918 known as The Order of St John and British Red Cross Society Act which allowed the surplus of the war fund, collected by the joint committee, to be used for the relief of the sick and suffering.

The following year, 1919, saw the death of 'the genius of the ambulance movement' , Sir John Furley, at the age of 83 years. He had been knighted in 1899, made a Companion of the

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Bath in 1902 and a Companion of Honour the year before he died. Needless to say he was honoured by the Order by being made a Knight of Justice and his name has certainly gone down in our history as a remarkable pioneer.

ST JOHN CADETS The idea o f a juveni le branch o f the Brigade was actually considered as far back as 1903 but it never became a reality unt i l March 1922. The official wording of the Brigade Order being 'Cadet divisions shall be formed for boys and girls to be attached to ambulance and nursing divisions and composed of two sections: senior 16-18 years and junior I 1-16 years'. The course of instruction was termed: 'preliminary first aid'. The cadet divisions grew rapidly and like the adult divisions they spread over the Empire.

Being an offmial youth organization the members learnt not only first aid and home nursing, but many proficiency badge subjects leading to the coveted Grand Prior Badge. Later the Special Service Shield was instituted and awarded to cadets who had given 1000 hours of voluntary service to the community. Summer camps were organized and proved to be very popular. In 1943 the cadets celebrated their 21 years of existence in a variety of ways through- out the Empire and over the years many cadets have rendered stalwart service. There are three distinct awards for cadet gallantry: the Life Saving Medal of the Order, Meritorious Certifi- cates and the American Cup for Gallantry, presented by the 8th USA Air Force during the SecondWorld War 'for the most outstanding act of heroism during the year'.

CONFERENCE The Brigade Surgeons' and Nursing Offmers' Conference, now held annually, has its origins in 1936 when a one-day conference was held in the Chapter Hall at St John's Gate on l0 October. A total of 29 out of a possible 54 county and district surgeons met under the chairmanship of Dr Corbet Fletcher, the surgeon-in-chief, assisted by his deputy, Dr Marcus Scott. Repre- sentatives came not only from England and Wales, but from Northern and Southern Ireland and the Channel Islands. As this venture was so successful it was decided to hold a full weekend conference the following year and this was organized by Ernest Milburn under the direction of the surgeon-in-chief's department. Subse- quently, conferences were held twice a year--in London during the autumn and in the North in spring. There was, however, a sad occasion

when on 28 April 1951 the newly appointed surgeon-in-chief, Dr F. H. Edwards, collapsed and died on the first day. He was eventually succeeded by Major White-Knox who held the post for the next ten years. During the Second World War he had given a course of first aid lectures to the late King George VI and Queen Elizabeth (the Queen Mother). Later he and Dr Scott re-wrote the famous first aid text book which became the first of the joint manuals, accepted by the three main organizations, St John, St Andrew's and BRCS. The third and present edition was written by Professor H. C. Stewart, director-general of the Association but who was, at the time, the principal medical offmer.

LATER DEVELOPMENTS Another important date to be mentioned is that of 28 February 1968 for on this day the Chapter General agreed to the merging of the Association and the Brigade, now known by the shortened title 'St John Ambulance'. (It must be stressed, however, that contrary to popular belief there is no apos t rophe ' s ' after the word John!) The union of the two great bodies thus formed the second foundation of the Order (the Hospital of St John in Jerusalem being the first).

The day after the merger a preliminary medical meeting was held and this resulted in the formation of the Medical Board, initiated by the surgeon-in-chief and it was decided to invite a past president of the Royal College of Surgeons to chair future meetings. The original members of the Board were: Sir Hedley Atkins (Chairman), Dr Marcus Scott (Surgeon-in- Chief), Professor Harold Stewart (PMO of the Association), Dame Barbara Cozens (CNO of the Brigade) and Brigadier Aubrey Miller (Chief Secretary of the Brigade).

Our organization endeavours to keep up to date with modern developments and in 1956 the air attendants came into being. They were followed in 1972 by the air wing and later joined forces to become the aeromedical service. This is a highly organized branch of the Foundation which will, at very short notice, supply a trained escort to fly with an injured or sick person from overseas, fly life-saving drugs, blood or trans- plant organs between distant places. Volunteer pilots and air attendants are strategically grouped throughout the United Kingdom ready for when an urgent call is made.

In these days of faster travel on congested roads, high speed machinery in factories and dangerous do-it-yourself apparatus in the home

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there is a very great need for adults and children to be well trained in both first aid and home nursing. The latter, now simply referred to as 'nursing', is a mandatory subject for all nursing personnel in the Brigade but not for the ambulance (male) personnel. There are, how- ever, more and more ambulance members of all ranks, both adult and cadet, who are taking the nursing certificate and this includes the present surgeon-in-chief, Dr J. Claverhouse Graham (the first holder of this office to gain the certifi- cate) and some of his Staff. In the latest year for which records are available, 1976, over 150 000 'first' certificates were awarded in England alone!

Apart from courses in first aid and nursing, conferences are held annually in leadership training and are very well attended by people

from various parts of the world. They give their time to learn and their services to humanity voluntarily.

In 1893 Queen Victoria reviewed 414 men of the Brigade in Windsor Great Park and later watched a demonstration of first aid by the nursing personnel. Her comment at the end of the day was: 'exceedingly well done and most useful'. Sixty years later the Brigade was reviewed by our present Queen, in the year of her coronation when more than 22 000 officers and members, adults and cadets of both sexes, paraded in Hyde Park--the largest gathering ever held there.

The members of the St John Ambulance Association and Brigade are proud to belong to the great Foundation which has served humanity through war and peace for 100 years.

Reque.stsfor reprints should be addressed to: Mr P. L. Adams, Secretary Medical Board, St John Ambulance, 1 Grosvenor Crescent, London, SW 1X 7EF.