1. It must be long enough to tie around the limb--a big handkerchief, towel or wide bandage.

2. There must be a pad to make the pressure over the artery greater than on the rest of the limb--a smooth stone, a darning ball, a large cork, cloth folded into a large pad or a rolled bandage.

3. The pad must be so placed that the artery lies between pad and the bone on the limb, in order that the pressure may stop the flow of blood by forcing the walls of the artery together between the pad and the bone.

4. Unless the tourniquet is put on tight enough, its application increases bleeding. It is extremely rare to find a tourniquet put on tight enough. In almost every such case removing the tourniquet will stop or partly lessen bleeding. A short stick or handle is needed, about a foot long, with which to twist the tourniquet sufficiently to stop the flow of blood. Usually it cannot be twisted tightly enough by hand alone. Tie the twisted part firmly so it will not slip, after it has been made tight enough to stop bleeding.

5. Remember, a tourniquet stops most of the circulation below it as well as in the cut artery, and must not be left in place too long for fear of injury to the rest of the limb by cutting off the circulation. _Usually it should not be left on for more than an hour._

_Bleeding from Veins_--Bleeding from the veins is not so dangerous as from an artery. The blood from the heart has to go through the little capillaries before it gets into the veins, and therefore the force of the heart muscle on the blood in the veins is not so great as in the arteries. The blood does not spurt out, but flows out as it would from a bottle tipped on its side.

You have already learned what to do to stop the bleeding from the smaller veins, and that it is not serious. From the larger veins, however, it can be very serious, and it may be necessary for you to put on a tourniquet before the doctor arrives in order to save the patient's life.

Almost always bleeding from a vein can be controlled by clean gauze or handkerchief pad and pressure by hand directly over the bleeding wound.

Tourniquets are almost never needed in bleeding from a vein. If necessary, it is wisest to apply them in the same way as for arterial hemorrhage and stop the circulation in the whole limb.

It is important to know in a general way where the blood vessels are in order to put the pad over them to stop the bleeding. Roughly speaking, the artery of the arm runs down about in a line with the inner seam of the coat. The large vein lies close beside it, carrying the blood back to the heart. The artery and vein of the leg run about in a line with the inside seam of a man's trousers.

_Stimulants_--In serious bleeding of any kind do not give stimulants until the bleeding has been stopped, as the stimulants increase the force of the heart and so increase the flow of blood. After the tourniquet is on and bleeding is stopped, if the patient is very weak, he may have a teaspoonful of aromatic spirits of ammonia in half a gla.s.s of water.

(a) SHOCKS; (b) APOPLEXY; (c) CONVULSIONS

(a) _Shocks_--In any injury, except the slight ones, the ends of the nerves in the skin are bruised or jarred. They send this jar along the nerves to the very delicate brain. The blood is drawn from the brain into the larger blood vessels, and the result produced is called shock.

If you have jammed your finger in a door sometime, perhaps you have felt a queer sick feeling and had to sit down. A cold sweat broke out all over you, and you were hardly conscious for a moment or two. This was a mild case of shock. In more severe injuries a shock to the brain may be very serious.

_Symptoms of Shock_--1. The patient may or may not be unconscious, but he may take no notice of what is going on around him.

2. The face is pale and clammy.

3. The skin is cold.

4. The pulse is weak.

5. The breathing is shallow.

In any serious injury the shock is liable to be severe and will need to be treated before the doctor arrives.

_Treatment_--Send for the doctor if serious.

1. Lay the patient flat on his back with head low, so that the heart can more easily pump the blood back into the brain.

2. Cover warmly; if they can be gotten, put around him several hot water bottles or bricks, being extremely careful to have them covered so that they will not burn him. Persons suffering from shock are more easily burnt than usual. Do not put anything hot next him unless it can be held against your own face for a minute without feeling too hot.

3. Rub the arms and legs, toward the body, but under the covers.

4. Give stimulants only after the patient has recovered enough to swallow, and when there is no serious bleeding.

_Stimulants_--Strong, hot coffee, or a half teaspoonful of aromatic spirits of ammonia in a half gla.s.s of warm water. The latter may be given if the coffee is not ready.

(b) _Apoplexy_--When a person has a "stroke" of apoplexy send for the doctor at once.

This condition resembles shock only in that the patient is unconscious.

The blow to the delicate brain does not come from the outside along the nerves, but from the inside by the breaking of a blood vessel in the brain, letting the blood out into the brain tissue and forming a clot inside of the brain, and thus making pressure which produces the unconsciousness.

_Symptoms of Apoplexy_--1. The patient is unconscious.

2. The face is usually flushed--red.

3. The skin is not cold and clammy.

4. The pulse is slow and full.

5. The breathing is snoring instead of shallow.

6. The pupils of the eye are usually unequally dilated.

_Treatment_--1. Lay the patient flat on his back with head slightly raised.

2. Do not give any stimulants.

3. Wait for the doctor.

(c) _Convulsions_--This condition resembles the foregoing shock and apoplexy in that the patient is unconscious.

_Symptoms of Convulsions_--1. The patient is unconscious.

2. The face is usually pale at first, but not so white as in shock, and later is flushed, often even purplish.

3. The skin is not usually cold.

4. The breathing may be shallow or snoring.

5. There are twitchings of the muscles of the face and body or a twisting motion of the body.

6. The pulse may be rapid, but is usually regular.

7. The mouth may be flecked with foam.

8. The pupils of the eye may be contracted or equally dilated.

_Treatment_--Convulsions come from various causes, and are always serious, therefore send for the doctor at once.

1. Put a wedge of some kind between the teeth if possible, the handle of a spoon protected by a cloth cover, or a rolled napkin does well. This is to prevent biting the tongue, which the patient is apt to do in unconsciousness with convulsive movements.

2. Lay the patient flat on his back, and prevent him from hurting himself in his twisting, but do not try to stop convulsive movement. It will do no good.

3. No stimulant is needed.