raised slightly so as to draw the tissue away from the wound, and a piece of thread tied under the needle so as to include a small amount of flesh, the ends cut off one-third of an inch from the knots, and then the needle withdrawn (fig. 178). After the hemorrhage has been checked by tying up the bleeding points and no serious bleeding occurs when the tourniquet is loosened, the wound may then be swabbed with tincture of iodine and closed by stitches, if it gaps widely, and a wick composed of a number of strands of thread left in the lower corner of the wound hanging out for about an inch for drainage. This wick is removed in 48 hours if no signs of inflammation occur, and the stitches can be removed in from five to six days.

In desperate cases, when all other measures fail, and the bleeding recurs every time the tourniquet is removed, it may be necessary to sear the bleeding point or places in the wound with a hot iron in order to check hemorrhage and save life. An iron rod, such as a poker, bolt, or large wire nail, may be heated for this purpose over any fire and should be sufficiently hot to thoroughly cook the flesh with which it is held in contact. After the wound has been seared no attempt should be made to close it with stitches.

AFTER TREATMENT OF SEVERE HEMORRHAGE IN GENERAL.

Patients who have lost a great deal of blood are in a weakened condition and may require careful after treatment. They should be kept in bed and all possible movement avoided. not even permitting them to go to the toilet in severe cases. The food should be light but nutritious and given in small quantities at frequent intervals. Milk toast, broth, and raw egg beaten up in milk, thin custards, etc., makes a good diet for the first few days. Afterwards it may be advisable to give doses of iron and strychnine to assist in building up the general strength. One-sixtieth of a grain of strychnine sulphate may be given three times a day, a half an hour before meals, and five drops of the tincture of iron in water at meal time, to be taken through a tube in order to avoid staining the teeth.

The patient should be kept in bed until his color has improved and should not be permitted to do hard work for some time.

BLEEDING FROM SPECIAL PARTS.

HEMORRHAGE FROM THE SCALP.

See wounds of the scalp, page 199.

HEMORRHAGE FROM THE FACE AND FOREHEAD.

The face has an abundant blood supply and bleeds freely when cut. Usually pressure with a compress against the bone underneath will be sufficient to arrest ordinary bleeding.

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If the blood comes in spurts from a wound of the forehead, apply pressure with the thumb in front of the ear, as the main artery passes up in this location (figs. 179 and 180).

WILDER

FIG. 179.-Blood supply of the face. Crosses show points for applying pressure to check hemorrhage.

A large artery which crosses the lower jawbone supplies the lips, cheeks, and nose. Severe bleeding from these localities may be controlled by pressure on this artery made against the jaw about 24 inches from the point of the chin (figs. 179 and 182). In endeavoring to stop hemorrhage by pressure of the fingers on a main artery, it may be necessary to shift the position of the fingers slightly in various directions until the proper spot is located.

HEMORRHAGE FROM THE NECK.

There are many large blood vessels in the neck, and if one or more of these are severed furious bleeding results.

First-aid treatment.-It

is impossible to apply a tourniquet to the neck, as it would cause immediate suffocation. Pressure inward and backward against the backbone should be made by the thumb, placed just above the breastbone. Make the pressures slightly from the side to avoid closing the windpipe (fig. 184). If the hemorrhage is very severe, push the first available material at hand, such as a handkerchief or the end of a towel, into the wound, and hold it in place with backward pressure against the backbone. Send for a doctor at once. Have the patient sit up in a chair.

FIG. 183.—Main arteries of the neck. Crosses show points for applying pressure to check hemorrhage from neck, shoulder, or arm pit.

After treatment.-It will be necessary to hold the compress in place or a long period. Several persons may relieve each other in this

work. If artery forceps are available, it may be possible to grasp the bleeding vessels and tie them with boiled heavy thread.

HEMORRHAGE FROM THE TRUNK.

Tourniquets can not be used to check bleeding from wounds of the chest, back, or abdomen. Hemorrhage from such localities is controlled by pressure, and when that fails by packing.

HEMORRHAGE FROM THE PALM OF
THE HAND.

Bleeding from deep wounds of the palm may often be checked by placing a large, firm, ball-shaped pad in the palm, closing fingers around it tightly, and bandaging them in place. A round stone wrapped in a handkerchief makes an excellent emergency pad for this purpose.

FIG. 184.-Point of applying pressure to check hemorrhage from the neck.

HEMORRHAGE FROM THE NOSE.

If it becomes necessary to check nosebleed the patient should be placed in a semirecumbent position, that is, lying on a bed or couch with shoulders and head slightly elevated. This can be easily done by placing a tipped-over chair behind the patient (fig. 186). A flexible roll about 2 inches long and one-third of an inch in diameter should then be made out of newspaper or muslin and forced under the upper lip. This pad goes well up between the gum and the lip and does not rest on the teeth. It should be firmly pushed in place and should put the lip under considerable tension. The patient should remain absolutely quiet and should on no account blow the nose, as this will detach the clot and the hemorrhage will start afresh. Ice applied to the back of the neck will sometimes prove effective. If these remedies fail and the hemorrhage continues for a long time, as a last resort it may be necessary to pack the nostril. This is done by introducing into the nose a long strip of gauze or mus

FIG. 185.-Point of applying pressure to check hemorrage from the shoulder or armpit.

lin about an inch and a half wide by means of a blunt end of a penholder or a similar blunt-pointed instrument. The gauze should be packed in firmly, filling the back part of the nostril first and gradually working forward. One end of the strip should be left out of the nose in order to facilitate its removal.

HEMORRHAGE FROM A TOOTH SOCKET.

This can often be checked by holding ice water or hydrogen peroxide in the mouth. Failing in this, make a cone-shaped pad of gauze or cotton, force it into the socket, and hold in place by closing the jaws tightly.

HEMORRHAGE FROM THE LUNGS.

Description.-Hemorrhage from the lungs occurs chiefly in tuberculosis, but may be caused by other conditions.

Treatment. The patient should be placed in bed in a semireclining position as shown in figure 186. An ice bag should be applied to the chest, or a towel rung out in cold water, which is frequently renewed. The patient should remain absolutely quiet, and if it is obtainable a quarter of a grain of morphine should be given by the mouth, or 10 drops of tincture of opium, or a teaspoonful of paregoric. It is of no use to give the patient salt as is frequently advised. Blood from the lungs is coughed up, is more or less frothy, and is often bright red in color.

HEMORRHAGE FROM THE STOMACH.

Description.-Hemorrhage from the stomach occurs in ulcer of the stomach, also in cancer and other conditions. The blood is vomited up and generally mixed with food, and may be bright red or dark brown in color.

Treatment. Place the patient in bed in a semireclining position. Allow him to swallow small pieces of ice. These should be actually swallowed and not sucked. If hydrogen peroxide is available a teaspoonful in a little water may be given. If antipyrin is at hand give 10 grains. Keep the patient absolutely quiet and allow no food for at least four hours after all bleeding has ceased. The diet at first should be liquid.

HEMORRHAGE FROM PILES.

Where the bleeding from piles becomes excessive the patient should keep off his feet as much as possible, and in severe cases go to bed. The hips should be elevated upon a pillow, and an enema of 4 ounces of ice water may be injected into the rectum by means of a fountain syringe, and cloths rung out in ice water or an ice bag applied to the