a simple fracture may easily be converted into a compound and much more serious one.

A dislocation is displacement of one of the bony structures of a joint from the other. It may be, like a fracture, either simple or compound, or complicated with some other injury. The principal signs of dislocation are pain, impairment of motion, alteration in the length of the limb and in the direction of its axis. It is often difficult to distinguish it from a fracture. With a fracture only, crepitus may usually be obtained, the deformity is easily reduced, but returns as soon as the extension is discontinued, the pain continues after reduction, and the limb is never abnormally long. Where a dislocation exists alone, crepitus is rare, the deformity is not easily reducible, but when reduced is not likely to return at once, the pain is always relieved by reduction, and lengthening may exist. A dislocation is always accompanied by more or less laceration of the ligaments, and contusion of the adjacent soft tissues. Chloroform or ether is usually given to secure muscular relaxation, and reduction then effected either by gradual manipulation or forcible extension.

Laceration or stretching of the ligaments, with twisting of the joint, short of displacement, constitutes a sprain. Such an injury is very painful, and it often takes longer to recover from it than from a fracture. The tendency to inflammation is discouraged by entire rest, elevation of the sprained joint, and cold applications. When it is first used again, it is customary to support it by bandaging or strapping.

Abnormal rigidity of a joint, resulting from injury, disease, or disuse, is known as anchylosis.

CHAPTER XVII.

The uses of bandages-Rollers-The spiral bandage-The figure-ofeight-Ways of applying them-Many-tailed bandages-The triangular bandage—Slings-Elastic bandages—Strapping.

BANDAGES are used to fix dressings in place, to give support, apply pressure, or prevent motion. Those in general use are the roller, single or double, the manytailed, and the triangular bandages. Roller bandages are strips of muslin or flannel, from half an inch to eight inches wide, and from three to twelve yards long, evenly and tightly rolled upon themselves. If made of any material that will not tear evenly, they must be cut by a thread, to insure regularity of width, and avoid fraying of the edges. The selvedge and all loose threads. must be trimmed off. If a bandage is to be wet, it is best made of something that has been washed, or inconvenience may arise from its shrinkage. An old cotton sheet is good material. To piece the strips, lay the two ends flat on each other, overlapping for an inch, and baste together all four sides, leaving raw edges. They must be rolled as tightly as possible, either on a regular bandage roller, or by hand. A double-headed roller is made by rolling a bandage from both ends toward the center, or by basting together two single rollers.

To put on bandages neatly and well is a good deal of an art, and one for which no exact directions can be given. There are a few general principles to be borne

in mind, and then adaptations are to be made in each case to the shape of the part over which the bandage is to be applied, and to the object in view. A well-fitting bandage must lie smoothly, without wrinkles, making an even and not too severe pressure. It must not be loose enough to slip, nor tight enough to be painful or to impede the circulation. A tight bandage can be loosened a little without removing it, by cutting half through each turn, but, if this does not give sufficient relief, it must be taken entirely off. Inexperienced bandagers are very apt to make them too tight, in the effort to avoid wrinkles.

In putting on a roller bandage, unwind no faster than is necessary, keeping the roll close to the body. In taking one off, roll or gather it up in the hand as fast as you unwind, keeping it in a compact form. For bandaging fingers and toes, a roller half or three quarters of an inch wide is used, for the hand an inch, for the head or arm two or two and a half inches, for the legs two and a half and three inches, and for the body six or eight.

Nearly all kinds of bandaging are variations and combinations of two simple forms, the spiral and the figureof-eight. A simple spiral bandage goes round and round, each turn overlapping the one before it by one third its breadth. This can only be used over a nearly straight part. To accommodate it to the shape of a limb, reverses have to be made. This is done by placing a finger on the lower edge to hold it firmly, and turning the bandage downward over itself at an oblique angle. This brings it the other side out, and changes its direction. These turns can be made as often as needed, whenever the bandage will not otherwise fit smoothly. They should not be made over a prominence of bone,

but are best at the back or on the outer side of the limb. The figure-of-eight bandage is more generally used than the spiral, as it fits better, and is, when familiar, more easy of application. It is especially well adapted for carrying a bandage past a joint. It is applied alternately above and below the joint, or some central point, the roll being carried obliquely over it. As in the spiral, each turn covers two thirds of the preceding. angles where the folds cross should be equidistant, and should succeed each other in a straight line. The figure-of-eight needs fewer reverses than the spiral bandage, but they are to be employed as occasion requires. The spiral and the figure-of-eight may be used singly or in combination.

The

In bandaging any limb, begin always at the extremity, and work toward the center of the body from left to right. Hold the roller with the outer side next the limb, until reverses are called for.

To cover a foot, start the free end of the bandage at the instep, and make a turn around the base of the toes. Then carry the bandage diagonally over the foot, across the point of the heel, and back from the other side till it coincides with the first turn. Cover this, and carry a second turn around the heel, half an inch higher than the first continue to make alternate turns under the sole and behind the heel, crossing over the instep, until the entire foot is covered. Finish with a couple of circular turns around the ankle, or continue up the leg.

In finishing off a bandage, make one or two straight turns, fold under the end and pin it, or split the last quarter of a yard through the middle, wind the ends in opposite directions around the limb, and tie them in a bow. A bandage to cover the groin is commenced with two turns about the thigh; the roller is then carried

diagonally to the opposite hip, round the waist, and downward, crossing the first oblique fold in front of the thigh. Another turn about the thigh follows in the same direction as the first, and the same course is repeated, leaving proper spaces, and making a series of figures-of-eight, till the bandage is carried sufficiently far. A bandage of this form, a figure-of-eight which includes two distinct parts of the body, is called a spica. This may be used either by itself or as a continuation of the leg bandage.

To bandage a hand, begin at the tip of the first finger, and cover it by a succession of close spirals or figures-of-eight to its base. Then make a turn around the wrist to keep these from slipping, and return to the root of the second finger. Lead the bandage by one or two spirals to the tip of this, and then proceed down it, as upon the first finger, concluding with another turn about the wrist. Cover each finger successively in the same way. Then take a slightly wider bandage, start it at the back of the hand, and wind it around the base of the fingers. Carry it obliquely across the back of the hand, around the wrist, back to the further side, and again around the palm. Continue these turns alternately till you have a line of crosses straight down the back of the hand, and the palm is completely covered. The thumb is finally to be dressed by making alternate turns over it and around the wrist. This is sometimes called the spica for the thumb. Before covering the palm of the hand, put a little absorbing cotton in it. Do the same at the flexures of any large joint that is to be covered by a bandage, to make it fit better, to absorb perspiration, and prevent chafing. This is especially important at the axilla.

A spica for the shoulder may be put on in much the