Also directions for opening, manufacturer's name, and date of contract.

b. The shell-wound dressing consists of:

(1) The compress composed of 1 square yard of absorbent sublimated (1:1,000) gauze, so folded as to make a pad 6 by 9 inches. Across the back of each end of this compress is placed a piece of gauze bandage 3 inches wide by 48 inches long projecting beyond the compress 21 inches on each side. These bandages are held in position by stitching along the edges of the compress; the tails are loosely rolled and placed on the back of the compress. The compress thus made is wrapped in parchment or waxed paper.

(2) One bandage, 3 inches wide by 5 yards long, of absorbent sublimated (1:1,000) gauze, loosely rolled and wrapped in parchment or waxed paper.

(3) Two No. 3 safety pins wrapped in waxed paper. The whole dressing is wrapped in tough paper with directions for application printed thereon. The short bandages sewed to the compress are for the purpose of temporarily fixing the compresses on the wound, after which it is firmly bound on by the roller bandage.

c. Directions for applying first-aid packet. Carefully remove the wrapper and proceed as follows:

(1) If there is only one wound, carefully remove the paper from one of the two packages without unfolding compress or bandage and hold by grasping the outside rolls of bandage between the thumb and fingers. When ready to dress wound, open compress by pulling on the two rolls, being careful not to touch the inside of the compress with fingers or anything else. Still holding one roll of the bandage in each hand, apply the compress to the wound, then wrap the bandage around the limb or part and tie the ends together or fasten with safety pins. The second compress and bandage may be applied over the first or it may be used for a sling if the arm is wounded or to bind both legs together if one is injured.

(2) If there are two wounds opposite each other, apply to one wound a compress with unrolled bandage and hold it in place by the bandage of the compress used to cover the other wound.

(3) If there are two wounds not opposite each other tie a compress over each.

(4) If the wound is too large to be covered by the compress, find and break the stitch holding the compress together, unfold it, and apply as directed above.

(5) Be careful not to touch the wound with your fingers nor handle it in any way, for the dirt on your hands is harmful, and you must disturb a wound as little as possible. Never wash the wound except under the orders of a medical officer. The bandaging will stop ordinary bleeding. Generally this is all that is necessary for the first treatment, and sometimes it is all that is needed for several days. The importance of the care with which this first dressing is made can not be too seriously insisted upon. It is better to leave a wound undressed than to dress it carelessly or ignorantly, so that the dressing must soon be removed.

(6) Always remember that if the contents of one packet is not large enough to cover a wound thoroughly, you should use several packages or enough to insure that the wound is well covered and protected.

(7) Be careful to keep your fingers out of the wound.

(8) Make no attempt to clean the wound-simply cover it with a dressing and bandage.

129. Bandages and slings.-In addition to the slings made with the bandages, two forms of slings provided by the ordinary clothing are shown here.

WOUNDS AND HEMORRHAGE

130. Wounds.-a. Wounds may be very small or quite large, either as a scratch on your hand which is a small wound or a crushed leg, which is a very large wound. All wounds will bleed more or less. Now and then a wound will bleed very freely, because a large blood vessel has been wounded; and you must know how to stop the bleeding, or hemorrhage, as it is called. Remember that all wounds bleed a little, but that as a rule this bleeding will stop in a few minutes if the patient is quiet, and that the firm pressure of the pads and bandage will keep it controlled. Occasionally, but not often, something else must be done.

b. In the first-aid treatment of wounds always remember to dress and splint, if possible to do so, all bad flesh wounds the same as you would a fracture. This will insure immobility and tend largely toward the prevention of bleeding. Looking upon the heart as a pump you will understand that to stop the current of blood pumped through the arteries you must press on the blood vessel between the wound and the heart. Pres

stops the current of blood in the same way that you would the flow of water in a leaky rubber hose or tube by pressing

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 hemorrhagethat 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.

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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 66 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

(1) Gently straighten the limb.

(2) Never use force.

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