(b) _Fractures_--_Broken bones_--There are two cla.s.ses 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 pa.s.sing 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 circ.u.mstances.

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.

[Ill.u.s.tration: Tourniquet

Showing where stone for pressing against artery is placed

Loop through which stick for tightening is inserted]

_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: