germs. (See "Dressings.") If the wound is very severe there is often shock, and that should be treated as described above. (See "Shock.")

FRACTURES.

A fracture is a break in a bone caused by direct or indirect violence. Fractures are the most important class of injuries with which we have to deal, not only because they render the victim a cripple for the time being, but because the further usefulness of the limb depends upon the recognition of the trouble and its proper immediate treatment. Frequently ignorance or carelessness in handling a fracture in the beginning renders the sufferer an invalid or cripple throughout his life.

From the standpoint of the first-aid man the following kinds of fracture only need be studied: Incomplete, complete, simple, and compound. In an incomplete fracture the bone is not entirely broken. It occurs most frequently in the young and is often spoken of as a green-stick fracture. In a complete fracture the bone is broken completely in two. In a simple fracture the broken bone does not protrude through the flesh; that is, the flesh around the fracture is not injured. In a compound fracture either one of the broken ends protrudes through the flesh or else the force that caused the fracture cuts or tears the flesh down to the bone. A compound fracture is nearly always accompanied by a loss of blood and a more or less severe shock.

The symptoms are: Pain, swelling, discoloration, abnormal motion, loss of power, and crepitus or grating of the bone ends together.

TREATMENT.

In examining the fracture, great gentleness in handling the part should be exercised. The limb should be handled as little as possible. If the nature of an injury is in doubt, it should be treated as a fracture until the doctor arrives. Never allow a person suffering from a broken limb to be moved until the part is properly supported by splints. To treat a fracture, draw the fractured limb into a natural position and fix it there by the application of splints. (See "Dressings.")

DISLOCATIONS.

A dislocation is a complete separation or displacement of the surfaces of a joint, caused usually by direct violence, but may sometimes be produced by indirect violence or sudden muscular contraction. Dislocations are always painful, because they are accompanied by wrenching and tearing of the ligaments about the joint and are sometimes complicated by a rupture of the muscles and by injuries to surrounding vessels and nerves.

Dislocations are classed as simple, compound, and complicated. In a simple dislocation the articular ends are separated without injury to the surrounding tissues. In a compound dislocation the ligaments around the joint are torn. In a complicated dislocation the muscles, vessels, and nerves are injured.

The symptoms are: Pain, swelling, discoloration, rigidity; the natural position of the limb is changed; the length is altered.

TREATMENT.

Restore the bone to normal position and hold it in place. To properly reduce the dislocation, some surgical skill and knowledge of the anatomy of joints are required. First-aid men should never try to reduce any dislocations except those of the jaw and fingers.

SPRAINS.

A sprain is a twisting or wrenching of a joint, producing a tearing of the ligaments and sometimes of the surrounding soft parts. It is followed by severe pain and marked swelling and discoloration. Sprains are important injuries and should be properly treated immediately, as sometimes permanent disability may follow failure to give them proper care. They are very often more serious than a fracture.

TREATMENT.

Let the injured person rest; elevate the injured part and fix it in place either with splints or by wrapping the joint tightly with a roller bandage or with adhesive plaster. Give hot or cold applications by placing the injured part in hot or cold water or by the application of towels wrung out of ice water or hot water.

STRAINS.

A strain is the wrenching or tearing of a muscle or tendon and is usually caused by violent exertion or sudden unexpected movements. A strain generally occurs in the muscles or tendons of the arms or legs. The symptom is sudden, sharp, excruciating pain.

TREATMENT.

Let the injured person rest; bandage the injured part tightly or apply adhesive plaster. It is sometimes necessary to prevent movement of the part by splinting.

BURNS AND SCALDS.

Burns are caused by exposure of the body to dry heat, such as the heat of fire or explosions of gas and powder, whereas scalds are produced by moist heat, as the heat of boiling water or steam. The danger from a burn depends on its depth and extent, and also on the age and general condition of the person injured.

Burns are divided into three classes according to depth. A firstdegree burn is simply a scorching or reddening of the outer surface of the epidermis (skin). A second-degree burn involves and destroys the entire thickness of the skin. A third-degree burn destroys not only the skin but also the tissue beneath, sometimes entirely to the bone.

The symptoms in a first-degree burn are: Severe, burning pain, reddening of the skin, formation of blisters; in a second-degree burn, destruction of the skin; in a third-degree burn, destruction of the skin and some of the tissue beneath. In severe burns shock is present.

TREATMENT.

Carefully remove the clothing from the burned surface and exclude the air as quickly as possible (see "Dressing of burns"), and treat for shock (see "Shock").

ELECTRIC SHOCK.

Accidents from electricity are common about mines. The ordinary trolley wire in mines carries 500 volts, incandescent and arclight currents carry 2,500 to 3,000 volts. Contact with a live wire, and the passage of these powerful currents through the body, cause dangerous shocks, burns, and even death. Live wires throughout the mines should be carefully insulated and men working about electric machinery should be careful to avoid contact with wires.

The symptoms of electric shock are: Sudden loss of consciousness; absence of respiration, or if present, very light and may not be observable; very weak pulse; and burns at point of contact. Always rescue a sufferer as quickly as possible, being careful not to get in contact with the live wire. Lose no time in looking for a switch for turning off the current; if there is one near at hand open at once. If there is a drill, mine auger, or any piece of wire at hand throw it across the trolley wire and rail at once. By so doing the circuit breaker in the power house will be thrown out and the current cut off. Such action may cause injury to the other working parts of the mine, but when a human life is at stake, all the wires should be cut if necessary. Life should come first and the mine afterwards. wire or drill long enough to reach from the wire to the rail is at hand, you may proceed to remove the victim from the current, but first get a dry board, piece of wood, or paper and put it under your feet, and protect the hand you use with your cap, coat, or anything dry, so as not to make a circuit. If possible use one hand only, placing the other behind you. If you do use both hands to remove the man from the ground, make sure that both your hands and your feet are well insulated so that you will not be caught in the same contact as your patient.

If no

Another way is to take your belt or handkerchief or a piece of rope and loop it over the patient's feet if he is lying on the wire, and thus pull him off. If an ax is near at hand use it to cut the wire, but first make sure that the handle is dry.

PREATMENT.

After the patient has been freed from the wire loosen the clothing about his neck, chest, and abdomen and perform artificial respiration. (See "Artificial Respiration.")

SUFFOCATION AND ASPHYXIATION.

Suffocation or asphyxiation may be caused either by something that blocks the windpipe and prevents air from entering the lungs, or by the inhalation of gas that acts as a poison itself or prevents the air from entering the lungs. The most common causes of suffocation and asphyxiation about mines are smoke, carbonic-acid ges, and carbon-monoxide gas.

TREATMENT.

Quickly get the patient to fresh air, loosen the clothing about the chest and abdomen, and perform artificial respiration.

There are several methods of performing artificial respiration. The two most effective methods, namely, the Schaefer method and the Sylvester method, are described below. The following description of the method of teaching and applying the Schaefer method was prepared by the commission on resuscitation from electric shock, representing the American Medical Association, the National Electric Light Association, and the American Institute of Electrical Engineers. The commission recommended the Schaefer over all other methods.

SCHAEFER METHOD OF ARTIFICIAL RESPIRATION.

Free the victim from electric current and instantly remove him to fresh air. Rapidly feel with the finger in his mouth and throat and remove any foreign body (tobacco, false teeth, etc.); then begin artificial respiration at once. Proceed as follows:

Lay the subject on his belly with arms extended as straight forward as possible and with face to one side so that the nose and mouth are free for breathing (fig. 7). Let an assistant draw forward the subject's tongue.

Kneel straddling the subject's thighs and facing his head; rest the palms of your hands on the loins (on the muscles of the small of the back), with the fingers spread over the lowest ribs (fig. 7).

With arms held straight, fingers forward, slowly swing forward so that the weight of your body is gradually and without violence brought to bear upon the subject (fig. 8). This act should take two to three

seconds. Then immediately swing backward so as to remove the pressure, returning to the position shown in figure 7. Repeat regularly 12 to 15 times per minute the swinging forward and backward, completing a respiration in four or five seconds.

FIGURE 7.-Schaefer method of artificial respiration. Inspiration.

As soon as this artificial respiration has been started and while it is being conducted an assistent should loosen any tight clothing about the subject's neck, chest, or waist. Continue the artificial respiration without interruption until natural breathing is restored (if necessary two hours or longer) or until a physician arrives. If natural breathing stops after having been restored, use artificial respiration again.

scious.

Give the patient fresh air, but keep him warm.

Send for the nearest doctor as soon as the accident is discovered.