slight. It is very much easier to check hemorrhage from a vein than from an artery as the blood rushes from the artery so rapidly that there is no time for the formation of a clot in the vessel. Blood from a cut artery flows in spurts or a fine jet, and it is bright red. Blood from a cut vein flows steadily, does not spurt, and is dark red in color. Blood from cut capillaries flows steadily and is bright red.

ORDINARY BLEEDING.

In most wounds there is simply hemorrhage from the capillaries. The blood is red and flows steadily for a few moments, then the flow becomes slower and finally loss of blood spontaneously ceases. Bleeding, from by far the greater majority of wounds, is of this type. Such slight hemorrhage in reality is beneficial because it serves to wash bacteria out of the tissues if any have been deposited there. If bleeding from ordinary wounds does not cease spontaneously, it can practically always be checked by placing a pad of gauze over the wound and pressing it against the wound either by the hand or a bandage, in the meantime elevating the injury if it is in the arm or leg (fig. 162). Many wounds are on the extremities and this simple expedient of applying pressure and raising the part will be all that is required to control the bleeding in most cases.

Occasionally a wound of this kind begins to bleed a second time after it has been dressed for an hour or two. This may be due to the fluid blood which is in the dressing acting as a poultice on account of the heat of the body. In these cases removing the dressings, elevating the part, and exposing the wound to the cool air, will cause the hemorrhage to stop and a new dry dressing can then be applied.

Reference is frequently made to slight bleeding and severe bleeding, but it may be difficult for the inexperienced to decide just what is meant by these terms, as any loss of blood is disturbing to the patient and the bystanders. In deciding whether or not bleeding should be classed as severe it should always be remembered that even a small quantity of blood will make quite an alarming stain on the linen or clothing, but the important thing is to note the rate at which the blood is actually escaping from the wound itself. The wound should be exposed for this purpose, with the patient sitting or lying quietly in a comfortable position. If the total blood escaping from the wound falls from the part in separate drops, the bleeding can hardly be called severe.

Sometimes a small amount of bleeding will continue for a long time. If the loss of blood is negligible, in such a case it is generally customary to proceed with the dressing, relying upon the pressure of the gauze to ultimately stop the hemorrhage.

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Anything which makes the heart beat faster will increase hemorrhage, hence it is unwise to give stimulants to bleeding patients unless absolutely necessary to save life, and in all cases they should be kept in a recumbent or semirecumbent position and as quiet as possible.

Do not put styptics, such as Monsel's solution, turpentine, cobwebs, and similar substances in wounds to stop bleeding. Bleeding can be controlled by other methods, and the use of styptics is undesirable as a general rule.

OOZING.

Occasionally considerable oozing will persist from a wound which is possibly not deep but extensive. Such oozing can almost always be controlled by the pressure of a properly applied compress, but if this fails the wound may be irrigated with hydrogen peroxide, which is an excellent means of stopping such loss of blood. In the absence of hydrogen peroxide very cold water or water as hot as can be borne should be tried. Do not, however, use lukewarm water, because it will increase the bleeding instead of diminishing it.

VENOUS HEMORRHAGE.

When a vein has been cut the blood wells up in the wound steadily and is dark red in color, sometimes almost black. If the vein is large, the blood flows rapidly, and a considerable amount may be lost. Such hemorrhage can be stopped by simply pressing a pad of sterile gauze over the wound and then elevating the part, having the patient lie down.

BLEEDING FROM VARICOSE VEINS OF THE LEG.

Occasionally these veins rupture and rather profuse hemorrhage occurs. In such a case the proper treatment is to lay the patient down, raise the leg and foot well in the air, and apply a clean gauze pad or as clean a pad of muslin as can be obtained on the ruptured vein, making light pressure on the compress with a bandage. Be sure to remove all garters or other constricting bands. If the hemorrhage continues in spite of this treatment the effort of loosening that part of the bandage which is between the heart and the wound should be tried. It may be that the bandage is improperly placed and is obstructing the return flow of blood to the heart and increasing the hemorrhage.

PACKING A WOUND TO CHECK HEMORRHAGE.

Where the hemorrhage is of a moderate amount it is always best to try the effect of elevation and pressure first. If these fail and the bleeding continues persistently it may be necessary to resort to pack

ing the wound. Packing a wound is very similar to stopping a small leak in a boat by forcing a strip of muslin into the opening, and any person of ordinary intelligence can learn how to do it. The procedure is somewhat in the order of a minor surgical operation and should not be undertaken if it can be avoided, as germs may be carried into the wound by the procedure.

RULES FOR PACKING WOUNDS.

1. In first-aid work if a doctor will arrive soon and severe bleeding of an extremity can not be stopped by elevation and the pressure of a pad on the wound, apply a tourniquet (p. 208).

2. If it is certain that medical aid can not be obtained in 4 hours, and the bleeding can not be checked by pressure and elevation of the part and becomes alarming, pack the wound.

3. Packing is also used to control hemorrhage from wounds of the trunk or neck which can not be controlled by pressure. Tourniquets, of course, can not be applied in these localities.

PREPARATION FOR PACKING A WOUND.

Everything which goes into the wound should be sterile, hence it may be necessary to apply a tourniquet (p. 208) to stop the bleeding while suitable preparations for packing are being made. The tourniquet should be loosened as soon as everything is ready. The bleeding may not recur, in which case packing will not be required. If bleeding of importance starts when the tourniquet is loosened, pack the wound.

Strips of sterile gauze or iodoform gauze make excellent packing material. If these are not at hand, strips of clean muslin may be boiled for 10 minutes, the water poured off and the strips dried as well as possible by continuing to heat them in the pan with the lid off. Be sure there is enough material to fill the wound tightly. The muslin can be boiled at the same time as the instruments but in another pan.

METHOD OF PACKING.

Scrub the hands carefully for 10 minutes in soap and water, changing the water frequently. Then soak them in a 1-2,000 bichloride of mercury solution if available. In the meantime boil in a pan on the stove a pair of scissors, a hairpin, a stick of wood similar to a penholder in size and shape, and a pair of dressing forceps and artery forceps if they are at hand. Pour the water off of the instruments and allow them to cool in the pan without touching them. Dry out the strips of muslin or gauze if it has been necessary to boil them. Place the instruments and the pan of packing material, gauze or muslin, alongside of the patient. Wash the hands again.