(4) Splint the limb. You will find a description of splints and their uses and illustrations showing the method of application in T. R. 112-5.

b. Fracture of the arm.-Apply two splints, one in front, the other behind, if the lower part of the bone is broken; or to the inner and outer sides if the fracture is in the middle or upper part support by sling, as in Plate 9 (T. R. 112-5).

c. Fracture of the forearm.-Place the forearm across the breast, thumb up, and apply a splint to the outer surface extending to the wrist, and to the inner surface, extending to the tips of the fingers; support by sling, as in Plate 10 (T. R. 112–5).

d. Fracture of the thigh.Apply a long splint, reaching from the armpit to beyond the foot, on the outside and a short splint on the inside. (Pl. 11 T. R. 112-5.)

The military rifle may be used as an outside splint, but its application needs care. A blanket rolled into two rolls forming

a trough for the limb is useful. The bayonet and scabbard may be used to advantage in splinting fractures of the thigh and leg, as illustrated in Plates 12 and 13 (T. R. 112-5). The carbine boot may also be used.

e. Fracture of the leg.-Apply two splints, one on the outside, the other on the inside of the limb. When nothing better can be had, support may be given by a roll of clothing and two sticks, as shown in Plates 14 and 15 (T. R. 112-5).

Many surgeons think that the method of fixing the wounded leg to its fellow and of binding the arm to the body is the best plan for the field, as the quickest, and as serving the immediate purpose.

f. The object of all this is to prevent, as far as possible, any motion of the broken bone and so limit the injury to the neighboring muscles and to lessen the pain. Be very careful always to handle a broken limb gently. Do not turn or twist it more than is necessary to get it straight, but secure it quickly and firmly in one of the ways shown, and so make the patient comfortable for carriage to the dressing station or hospital. Time is not to be wasted in complicated dressings.

134. Other wounds.-There are, of course, many wounds of the head, face, and of the body, but for the most part you will have little to do with these except to protect the wound itself with the contents of the first-aid packet; or, if bleeding makes it necessary, use in addition several of the packet compresses to control it. As the surface blood vessels of the head and face lie over the bones and close to them, it will generally not be difficult to stop the bleeding by this means or by pressure

with the fingers, as already shown. Remember, as you were told, to make the pressure between the heart and the bleeding point. With wounds about the body, the chest, and abdomen you must not meddle, except to protect them, when possible without much handling, with the materials of the packet.

135. Cautions.-You have already been warned to be gentle in the treatment of the wounded, and the necessity for not touching the wound must be always in your mind; but there are some other general directions which you will do well to remember:

a. Act quickly but quietly.

b. Make the patient sit down or lie down.

c. See an injury clearly before treating it.

d. Do not remove more clothing than is necessary to examine the injury, and keep the patient warm with covering if needed. Always rip or, if you can not rip, cut the clothing from the injured part, and pull nothing off.

e. Give alcoholic stimulants cautiously and slowly and only when necessary. Hot drinks will better suffice when obtainable. f. Keep from the patient all persons not actually needed to help him.

OTHER ACCIDENTS AND INJURIES

136. Other accidents and injuries.-There are a few other conditions about which you should be informed, although they are not peculiar to military life, the first two only being related to wounds.

137. Poisoned wounds.-a. When a wound is known to be poisoned, such as one infected by the venom of a snake or a rabid animal, the treatment should be directed toward preventing the passage of the poison into the circulation. In snake bites the poison acts quickly. To prevent its absorption a bandage should be carried around the limb between the wound and the heart tight enough to compress the veins; then get the poison out of the wound by laying it open and sucking the poison out (if there is no crack in the mouth or lips), and destroying what is left by cauterization with fire or caustic. Stimulants may be freely given if the heart is weak. In the bite of a rabid animal the poison is for a long time localized in the wound, and there is no danger of immediate absorption. Do not use a tourniquet, but use the other local measures advised for snake bite.

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b. Bites from scorpions, spiders, and other insects are cases of poisoned wounds, and are treated locally by applying a solution of ammonia or baking soda. Give stimulants if necessary. SHOCK, FAINTING, POISONING, DROWNING, SUFFOCATION FROM GAS

138. Shock-a. By this term is meant a very severe physical and mental depression following extensive wounds, such as those produced by shell, and ordinary wounds in which the chest and abdomen are entered. You can hardly mistake this condition, for it resembles approaching death. If possible, the patient should not be moved, but kept in position where found, warmed, and carefully stimulated. This will be difficult, perhaps impossible, on the battle field, but it should be attempted unless removal is unavoidable. This condition is a very common one and nearly always follows all kinds of injuries. It is a condition of profound depression of the nervous system or a condition of collapse. It may follow the slightest injury, such as a prick or the scratch of a pin, and is always associated with all severe injuries, such as those resulting from railroad or machinery accidents, severe burns, and gunshot wounds.

The symptoms may be very mild in some cases-in fact, hardly noticeable and require no particular treatment. However, in severe cases the symptoms may be quite alarming and demand most vigorous treatment: otherwise the case may terminate in death.

b. Symptoms of shock.—You may recognize shock by means of a few of the well-known symptoms:

(1) The face is pale and pinched and has an anxious, frightened appearance.

(2) Patient feels weak and faint and may complain of chilly sensations.

(3) The skin is cold and clammy and the surface of the body covered with a cold perspiration, especially noticeable on the forehead.

(4) There may be nausea or vomiting, the pulse weak, rapid or irregular, or may be entirely absent and imperceptible. (5) The breathing is sighing and is irregular.

(6) The person may or may not be unconscious.

The condition closely resembles death and is one which usually causes the bystander or one anxious to help to become frightened and lose his presence of mind.

c. Treatment.-In all severe cases following bad accidents and severe hemorrhage:

(1) Send for a surgeon at once.

(2) Place the injured man in a horizontal position; raise the head slightly by placing a blanket or pillow under the head. (3) Loosen all tight clothing which might interfere with the breathing or retard circulation.

(4) Keep the body warm. The body may be kept warm by wrapping in blankets and placing hot-water bottles at the sides, along the extremities, and over the heart. You may also use hot irons, stones, bricks, plates, or glass bottles filled with hot water. However, it must always be borne in mind that the sensibility of an injured person is blunted or dulled-he may even be unconscious-so that he may not feel the heat, and if applied too hot or directly to the skin without protection very severe burns might result. Always wrap the hot-water bottle or any article used in a cloth of some kind so as to prevent burning. Rubbing the extremities with the hands or hot flannels will aid to restore circulation.

139. Fainting.-This condition is generally the result of severe bleeding or exhaustion from fatigue. The patient should be laid upon his back, head lowered, arms by the side, feet extended, and should be carefully stimulated. This condition is rarely dangerous.

The other important accidents or conditions with which you may have to deal are poisoning, drowning, sunstroke, heat exhaustion, burns, and freezing.

140. Poisoning.-a. Poisoning by way of the stomach may result from swallowing mineral or vegetable poisons. In the military service it often follows the taking of food which has undergone changes resulting in the production of poisonsptomaines, etc.

b. Whenever there is no evidence of caustic action, such as burns on the mouth, an effort should be made to empty the stomach and bowels by the free use of emetics and laxatives, such as a tablespoonful of mustard or common salt in a cup of warm water, as an emetic, and Epsom or Rochelle salts or castor oil as a cathartic. The cathartic should not be given until the vomiting resulting from the emetic has subsided. After the poison has been evacuated, give stimulants and apply heat and rubbing externally.

c. When the lips are burned, give no emetic; give olive oil, cottonseed oil, or castor oil internally, and also the proper antidote, if you know it.

141. Drowning.—a. Resuscitation.-Artificial respiration is required in cases of failure of respiration from drowning, from inhalation of gas, from electric shock, or from concussion of the brain.

Being under water for four or five minutes is generally fatal; but an effort to revive the apparently drowned should always be made, unless it is known that the body has been under water for a long time. It is of the first importance in attempting to revive cases of this character that artificial respiration be begun at the earliest practicable moment, as soon as the patient is on shore or in a boat; and it must be continued, in many instances, an hour and a half or two hours before the case is considered hopeless. After the patient begins to breathe, watch carefully to see that he does not stop again, and when he breathes faintly, assist him with artificial respiration. Do not attempt to raise the patient nor allow him to rise until breathing has become regular. As soon as the patient is removed from the water, lay him face down and, grasping him around his waise, raise his hips so that any water may drain out of the air passages while the head remains low. (Pl. 16, T. R. 112-5.)

Then proceed with the following method of artificial respiration, which can be carried out by one person without great exhaustion for one or two hours.

Schaefer method.--The man is laid on his stomach, face turned to one side so that the mouth and nose do not touch the ground, his arms extended from his body beyond his head. (Pl. 17, T. R. 112–5.)

In this position the tongue does not obstruct the air passages, but falls forward of its own weight, and the removal of any foreign body, tobacco, chewing gum, or false teeth, or of mucus, blood, or vomitus is facilitated.

The operator kneels, straddling one or both of the patient's thighs, facing the patient's head, and places his hands, with the thumb nearly parallel to the fingers, so that the little finger curls over the end of the lowest rib. The lower margin of the hand must be free from the pelvis and resting on the lowest rib. The ribs can be more easily located and the pelvis avoided by operating on the bare back of the patient.

The nearer to the ends of the ribs the heels of the hands (thenar and hypothenar eminences) can be placed without sliding off the better the position. Thus the hands are far removed from the spine and the fingers nearly out of sight. The fingers help some, but the chief pressure is exerted by the heels of the hands, the weight coming straight from the shoul