bone is broken the other acts as a splint and the symptoms of frac ture may not be clear. In cranking an automobile, if the motor backfires the crank will be violently whirled around in the reverse direction and frequently causes fracture of the forearm of the operator.

Symptoms of fracture of both bones of the forearm.-Pain, inability to turn palm upward and downward, possibly grating, false motion.

First-aid treatment.—Bend the forearm to a right angle with the arm. Apply two padded emergency splints extending from the elbow to the knuckle. Lay the forearm and the hand on the lower splint, gently straighten the part as well as possible, and place the other splint on the back of the hand and arm. Fasten in place the bandage or strips of muslin and support the arm and hand in a broad sling.

After treatment.-When the patient is in bed remove emergency splints, place arm and forearm on a pillow, try to restore bones to their natural position, and apply cold compresses for several days. When swelling is reduced make two splints of light wood about 3 inches wide and long enough to run from the elbow to the knuckle. Pad the splints well and apply to the forearm as directed above. Fasten the splints with strips of adhesive plaster, straps, or a bandage (fig. 266). Lay arm across the body with the thumb up in a broad sling (fig. 267). Keep the splints on for four weeks. Passive motion should be begun after three weeks, removing the splints daily for that purpose.

FRACTURES AROUND THE ELBOW JOINT.

Some surgeons treat all fractures around the elbow joint, either above or below, except fracture of the tip of the elbow (the olecranon) by Jones's position. The arm is bent at the elbow, placed against the side and the hand of the affected side held at the base of the neck by a bandage fastened around the wrist and suspended from the neck (fig. 268). This mode of dressing injuries around the elbow joint is extremely simple and recommends itself to the laity on that account. It is necessary, however, to observe certain things. After the hand has been placed in the proper position and fastened there with the dressings, the operator must be certain that he can feel the pulse at the wrist. It is also necessary to examine the arm daily for the first 10 days. If the swelling is growing worse the hand should be lowered a little. If the pulse can not be felt at the wrist it is necessary to lower the hand until such a point that the pulse returns. The arm is held in this position for from three to six weeks. At the end of the first two weeks the wrist is lowered an inch or so. At the end of three weeks the dressing should be taken off daily and a little passive motion applied very cautiously.

Considerable padding must be applied around the neck in order to prevent the pain which the weight of the arm will cause to that part of the body unless this precaution is carried out. A leather band around the wrist or a glove from which the fingers have been removed may also be utilized as a means of holding the hand in the desired position, the glove or leather band being fastened to the neck bandage by suitable strips.

FRACTURE OF THE ARM.

Fractures of the arm are common, but it is sometimes difficult to get union.

Symptoms.-Pain, shortening, inability to move the arm, and sometimes crepitus and false motion may be detected. The appear

FIG. 272. Method of cutting card-
board for shoulder cap.

FIG. 273.-Shoulder cap made.

ance of black and blue spots on the arm after an injury in places which have not been bruised themselves should suggest the likelihood of a fracture.

First-aid treatment.-Place a broad wedge-shaped pad between the chest and the arm long enough to extend from the arm pit nearly to the elbow. The edge of the wedge goes into the armpit (fig. 269). This pad may be constructed of towels or even folded newspapers wrapped in some soft material. It is held in place by a band or strips going over the opposite shoulder. The pad gives a firm, straight surface to support the arm on the inside. Apply three short narrow padded splints to arm running from the shoulder to the elbow, one on the outside, one behind, and one in front (fig. 270).

Hold the splints in place with a many-tailed bandage, or three strips of muslin. Fasten the arm to the chest with a bandage going around the rest of the body or with strips of adhesive plaster or a towel pinned in place. Place the forearm in a sling

and use a narrow sling supporting the wrist only (fig. 271).

After treatment.-For after treatment use the same dressings and splints more carefully applied, that is wedge-shaped pad between the arm and chest, three splints around the arm. Bring the forearm up so that it makes a right angle with the arm. Fasten the arm to the side by bandages and support forearm in a narrow sling at wrist. Allow splints to remain on for five weeks, frequently adjusting them and the bandages. A narrow sling is advisable here because it allows the weight of the forearm to help in overcoming shortening.

FIG. 274.-Shoulder cap applied.

In fractures near the shoulder joint, a shoulder cap should be applied in addition to the other dressings. The cap can be constructed of binder's board which has been softened in hot water, or heavy pasteboard (figs. 272, 273, 274). The binder's board should be long enough to run about halfway down the arm and wide enough when shaped to the arm to about half encircle the part.

FRACTURE OF THE SKULL.

Fracture of the skull may occur at the top or vault of the skull, or the lower part, when they are known as fractures of the base of the skull.

Fractures of the skull are serious injuries and may be due to blows, falls, or other accidents.

Fracture of the upper part of the skull can often be felt by running the finger over the scalp, the depression in the bone being easily detected. The gravity of fractures in this location depends largely on the damage done to the brain and blood vessels. If large arteries have been ruptured inside the skull the blood pours out and compresses the brain giving rise to symptoms of brain compression (p. 289).

Fractures of the base of the skull.-Fractures of the base of the skull are generally compound, the wound not being visible, but in the nose, pharynx or ears. They are of course very dangerous injuries.

Symptoms. There may be partial or complete loss of consciousness, bleeding, or the escape of blood-stained fluid from the nose or ears and paralysis of the face. Later the symptoms of compression may be developed such as paralysis, slow stertorous breathing, unequal pupils, etc. (p. 289).