upon it between the leak and the pump, or other source of power. The points or places where you can best do this for the different parts of the body are illustrated in the figures. These points are chosen for pressure because the blood vessels which you wish to control there lie over a bone against which effective pressure can be made.

(1) Points for compression with thumb and fingers are the temporal artery, which is reached by pressure with tips of fingers in front of the ear just above where the lower jaw can be felt working in its socket. A branch of this artery crosses the temple on a line from the upper border of the ear to above the eyebrow.

(2) The carotid artery may be compressed by pressing the thumb and fingers deeply into the neck in front of the strongly marked muscle which reaches from behind the ear to the upper part of the breastbone. Plate 3 (T. R. 112-5) shows pressure on the carotid of the left side.

(3) In bleeding from wounds of the shoulder or armpit the subclavian artery may be reached by pressing the thumb deeply into the hollow behind the middle of the collar bone. (Pl. 4 T. R. 112-5.)

(4) In bleeding from any part of the arm or hand the brachial artery should be pressed outward against the bone just behind the inner border of the large muscle of the arm. (Pl. 5 T. R. 112-5.)

(5) In bleeding from the thigh, leg, or foot, press backward with the thumbs on the femoral artery at the middle of the groin where the artery passes over the bone. The point is a little higher up than that indicated in plate 6 (T. R. 112-5).

c. There are two other simple means for helping to stop bleeding such as elevating or holding an arm or leg upright when these parts are wounded, and by applying cold to the wound; but you will find the compress and bandage, or the pressure made by your fingers as described, to be most useful in the great majority of cases.

131. Hemorrhage (commonly known as bleeding).—a. Hemorrhage or bleeding is the escape of blood from any of the blood vessels as the result of injury or cut. There are three varieties of hemorrhage or bleeding:

(1) Arterial, or that coming from the arteries, which is the most dangerous on account of the great amount of blood which may escape in a short time. In this form of hemorrhage the blood squirts from the artery with each pulsation of the heart and is bright red in color.

(2) Venous, from the veins. In this form of hemorrhage the blood flows in a slow, steady stream, and the color is dark red or purple.

(3) Capillary, which is merely an oozing of blood from a cut surface, and which is generally the least dangerous form, although it sometimes may be quite dangerous and difficult to control.

b. There are two general ways of stopping hemorrhage that is, naturally and artificially. The natural way of arresting bleeding is the method adopted by nature herself and is practically the process of forming a clot or plug in the blood vessel or wound which aids in the prevention of further escape of blood. A clot is a jelly-like mass of coagulated blood, the formation of which is hastened or aided by exposure of the wound to the air. In this way nature may be able to stop quite severe bleeding. However, in many cases nature is unable to stop hemorrhage in this way without the loss of a great amount of blood, which is naturally weakening to the patient and if left too long might result in the patient bleeding to death; thus we are obliged to apply artificial means. One of the most important points to remember is that the patient should be kept quiet.

132. Tourniquet.-a. When, however, the bleeding continues after you have used these simpler means, or your fingers become tired in making the pressure, which they may do after 10 or 15 minutes, you will have to use what is called a "tourniquet," and generally will be obliged to improvise one out of material at hand. The principle of such a tourniquet is easily understood-a pad or compress placed on the line of the artery and a strap or band to go over the pad and around the limb, so that when tightened it will press the pad down upon the artery and interrupt the flow of blood. In the arm, apply the tourniquet over the point shown for compression by the fingers; in the thigh, 4 or 5 inches below the groin, as it can not be applied higher up.

The pad or compress may be made of such an object as a cork or smooth round stone wrapped in some material to make it less rough, a bandage, a handkerchief, or a cravat being used for the strap. After tying the band closely around the limb, any degree of pressure may be made by passing a stick, bayonet, or something of that kind of sufficient length, and twisting or turning it around so that the pad is pressed firmly in place.

b. Improvised tourniquet.-Turn the stick slowly and stop at once when the blood ceases to flow, fixing the stick in place with another bandage. Remember that you may do harm in

two ways in using this rough tourniquet: First, by bruising the flesh and muscles if you use too much force; and second, by keeping this pressure up too long and thus strangling the limb. It is a good rule to relax or ease up on this or any other tourniquet at the end of an hour, and allow it to remain loose, but in place, if no bleeding appears. By watching you can tighten the tourniquet at any time if necessary.

c. Precautions to be observed in the application of a tourniquet:

(1) Never cover over or bandage a tourniquet.

(2) Mark the diagnosis tag plainly "tourniquet.”

(3) If the injured man is conscious, he should be instructed to tell every medical officer with whom he comes in contact that he has a tourniquet on.

(4) Lastly, remember if a tourniquet is left on a wound for six hours the limb will surely die.

FRACTURES

133. General instructions.-a. The next injury you must know how to help is a broken bone. The lower extremities, thigh and leg, are more frequently wounded than the upper, arm and forearm; and so you will find more fractures of the thigh and leg bones than of the bones of the arm and forearm. You will usually know when one of these long bones is broken by the way the arm or leg is held, for the wounded man loses power of control over the limb, and it is no longer firm and straight. What you must do is much the same in all casesstraighten the limb gently, pulling upon the end of it firmly and quietly when this is necessary, and fix or retain it in position by such splints or other material as you may have. This is called setting the bone. If you have none of the splint material supplied, many common materials will do for immediate and temporary use a shingle or piece of board, a carbine boot, a scabbord, a tin gutter or rain spout cut and fitted to the limb, a bunch of twigs, etc. Whatever material you choose must be well padded upon the side next to the limb, and afterwards secured or bound firmly in place, care being taken never to place the bandage over the fracture, but always above and below. In connection with applying first aid to fractures, always remember that you should

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(1) Gently straighten the limb.

(2) Never use force.

(3) Dress the wound, if there be one.

(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 The bayonet and scabbard may

a trough for the limb is useful. 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 werė 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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