367 MEDICAL of the top of the thigh, known as " the fold of the groin." As each branch enters the thigh it comes near the surface, and its pulse may be easily felt. The artery of the thigh passes downwards and inwards towards the flexure side of the knee, and, although well protected by its position, it is liable to accidents, which if not attended to with great promptitude may cause a speedy death. Behind the knee pulsation is again noticeable, but at this point the artery divides into two I Tovrniqijet on thigh to control femoral artery branches, which lie deeply embedded between the two bones of the leg. The two vessels pass over the ankle, and pulsation may be felt at the bend of the foot and also just below the pro- jecting bone on the inner side of the ankle. The course of the vessels through the foot is not important, as pressure must be exerted at one or both of the points at the ankle already men- tioned. We are now hi a position to understand how; to arrest arterial bleeding. The general rule is to apply pressure on a pressure point between the injury and the heart, but as far away from the heart as possible, so as not to cause more extensive numbness than absolutely necessary. The pressure must be exerted at a pressure point^e.e., where an artery, coming near the surface, has a bone behind it against which it can be pressed. Digital compression should be applied at once. The great drawback is that such pressure cannot be long sustained, and relief from other helpers is not always possible. The same kind of pressure can be ob- tained from a tourniquet, which can be extemporised from homely articles to do the work of the elaborate instruments employed by surgeons. Such instruments consist essentially of a strap round the limb, a pad to press on the artery, and a screw to tighten the strap so that the pad presses further and deeper on to the artery. A pad may be extemporised from any hard substance, such as a purse, a cork, a lump of wood, a stone, or piece of coal wrapped in a handkerchief ; the strap consists of a triangular bandage or its substitute, as described in Article I. ; and the screw is nothing more than a stick of wood, an umbrella, key, pencil, bayonet, policeman's truncheon, or any similar rodj tied in the knot of the bandage opposite the pad and twisted round and round until the pad presses sufficiently hard to prevent the flow of blood through the artery. The tourniquet must remain pressing on the artery until medical assistance arrives, but in case of long delay the screw may be loosened a little at the end of an hour, and, if no bleeding occurs, may remain slack, but it must be promptly re-screwed at the first return of haemorrhage. Briefly, the control of arterial bleeding may be detailed as follows : For bleeding in the palm of the hand : Apply a cone-shaped pad point downwards on the wound, bend the fingers over to press it, bandage them tightly with a narrow bandage, and put the arm in a wide sling with the hand high. For bleeding from other parts of the hand : Put a hard pad on each side of the front of the wrist, and bandage them firmly in position. For a wound irt the forearm : Place a hard pad in the bend of the elbow, bend up the fore- arm, and bandage it as shown for leg. For bleeding in the armpit: Control the subclavian artery, push a hard pad sufficient to fill the armpit against the wound, bind the arm tightly against the side, and put the fore- arm in a large arm-sling. The brachial artery must be controlled before attending to wounds in the lower arm, forearm, or hand. For bleeding in the lower limbs : From the sole of the foot : Control the circulation at the ankle. Apply a conical pad on the wound, and bandage it tightly. From the leg: Apply a hard pad, well pressed into the hollow behind the knee ; bend the leg and, bandage it. From the thigh : Control the circulation by pressure on the artery at the fold of the groin ; apply a tourniquet to the artery of the thigh. For bleeding from the head and neck : From the temple, front, or top of head : Compress t^e temporal artery by a hard pad, Leg flexed and tied to control arterial bleeding below the knee retained in position by a narrow folded triangular bandage crossed opposite the pad. From the face below the eyes : Compress the artery that passes over the edge of lower jaw, apply a hard pad, as above. From the neck : Apply digital compression to the carotid artery, and, when the bleeding has stopped, dress the wound, bend the head forward, and fix it in position with bandage^. To be continued.
