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are more commonly contracted, dilating when any attempt is made to arouse him. In apoplexy there is absolute unconsciousness, stertor and hemiplegia or complete paralysis. In opium poisoning the pupils are contracted to pin points and will not dilate and there is no paralysis. In uremia, paralysis and stertor are absent, unless there is apoplexy, and there is apt to be edema of the legs, and if the urine be examined you will find albumen. In all cases an examination of the eye ground is of considerable importance. In cases where there is doubt it should be treated as one of cerebral injury.

Treatment: A patient with concussion of the brain should be placed in a cool, dark room, free from any excitement of any nature, and sleep, contrary to the erroneous idea of the laity, should be encouraged. If shock be present, aromatic spirits of ammonia is better than alcohol, on account of the exciting effect of the latter to the brain, which we wish to avoid. We may also have to resort to external application, such as hot water bottles and sinapisms, to bring about reaction. When there is congestion or extravasation with subsequent inflammation, excellent results have been obtained from the use of the ice bag or Pettigoud's apparatus. In cases where these are not possible, cloths, wrung out in ice water, should be applied. In all cases a careful diet, with occasional purgatives and attention to the general hygiene, are essential. As regards the surgical treatment, the opinion of the profession is somewhat divided, but it seems quite rational that where there is inflammation as the result of the extravasation, with serious symptoms, the only course to pursue it to assist nature by trephining and allowing the hemorrhage to escape.

ANTERIOR-POSTERIOR FLAP FOR ALL AM

PUTATIONS.

Vance describes the operation as follows: "An ordinary wide-bladed scalpel is held with handle at right angles to the axis of the limb and entered on the side, a little below the point of proposed bone section, cutting through skin and cellular tissue, parallel with the axis of the limb two inches, then across the limb in a slight curve, ending the incision opposite the starting point. The ends of this incision represent the base of the anterior flap, which is dissected up. The posterior flap is made in the same way but shorter, so that when they are brought together the line of closure will be back of bone or bones, as it may be. With the same small knife the muscles are divided circularly at right angles to the axis of the limb and on a vertical plane with proposed bone section, the flaps being held up by an assistant with two pairs of single-tooth forceps, care being taken not to incise the periosteum; with the same knife the interosseus space is divided half an inch below the point of proposed bone section and a long anterior periosteal flap is lifted and held well up out of the way of the saw, which is introduced on a slant downward at an angle of 45 degrees, and the bone is divided for three-quarters of an inch and then re-entered vertically a little below the former point, both bones being completely divided. In this way the tibial crest is beveled before the limb is removed. Of course, when it is a

thigh or arm amputation this is not called for. In a leg amputation the fibula is shortened three-fourths of an inch with the saw, slanting upward. It is my custom to use constant irrigation over the part while bones the being sawed to prevent possible heat necrosis. The vessels are carefully isolated and tied with plain catgutNo. 3 for femoral, No. 2 for tibial vessels. The nerves are drawn down and cut off square, three-quarters of an inch above the muscular section, the hemostatic bandage is removed, small vessels torsionized, oozing stopped by hot sponging with salt solution or by irrigation with the same. The periosteal flap is sutured over the end of the bone by fine catgut. The flaps are accurately brought together by the interrupted silkworm gut sutures, four or five being sufficient, then a continued fine suture of plain catgut closing perfectly the whole line of incision, except one-quarter inch at outer angle, where a short rubber drainage tube is introduced. A full aseptic dressing finishes the operation. At the end of twenty-four or forty-eight hours the drain is removed and a second dressing applied, which is left on until the seventh day, when the silkworm gut sutures are removed and the stump is found firmly healed." The question as to where to amputate can be answered in a few words. The point of selection for the leg is seven inches from the floor or four inches above the ankle-joint. No operation between this point and the mid-metatarsal region is surgical unless it is perfectly evident that an artificial limb cannot be obtained. In all operations between this point. and four inches below the base of the patella the old rule of save all you can should be followed. The point of selection above the knee is three inches above the patella. All operations between the site of the last-mentioned tibial and the first femoral are unsurgical withAbove this point of selection the old rule of conservatism should be followed excepting in malignant disease, when it is a question whether to do disarticulation in the hip, or leave sufficient bone for an artificial limb, and as a rule he does the latter. The question when to amputate is a little harder to answer. In most cases it is easy, but occasionally difficult. If the surgeon thinks that there is a chance that the result of conservatism would be inferior to an artificial limb he should amputate, especially if he thinks the effort to save the limb is attended with greater risk. The patient frequently decides the question for him, but often disastrously. The difficulty then arises in case of chronic bone disease of ankle and knee. The chances of getting good results in conservatism in these is in proportion to the age. All malignant diseases of the bones, joints skin cancers, the rules being to get well above the proxor other parts call for amputation, excepting some of the imal point. Amputations for convenience are often indicated, the patient being more comfortable without the useless limb and with an artificial one. Frequently patients are thus converted from helpless cripples into useful members of society. In amputations of the hand or arm the rule of save all you can is to be followed, especially in laboring men.-Charlotte Medical Journal.

out reserve.

Syphilitic affection of the cervical glands occasionally is common in the secondary stage. Tertiary enlargements occurs in primary syphilis about the mouth or threat, and of the glands are sometimes met with, forming large masses, which are very difficult to diagnose.-Cheyne and Burghard.

NEW REGISTRATIONS.

Dr. H. N. Coutlee, Sherbot Lake, Can., local surgeon C. Pac.

Dr. George K. Johnson, Grand Rapids, Mich., chief surgeon G. R. & I.

Dr. F. M. Chrisolm, Baltimore, Md., ophthalmic and aural surgeon Western Maryland.

Dr. William O. Ensign, Rutland, Ill., local surgeon I. C.

Dr. R. S. Wallace, East Brady, Pa., surgeon Penna. Dr. F. R. Garlock, Racine, Wis., local surgeon C., M. & St. P.

Dr. J. N. Warren, Sioux City, Ia., chief surgeon W. & S. F.

Dr. M. S. Hosmer, Ashland, Wis., surgeon N. Pac. and W. C.

Dr. F. A. Stilling, Concord, N. H., chief surgeon B. & M. (S. Div.).

Dr. J. M. Evans, Evansville, Wis., local surgeon C. & N. W.

Dr. Charles W. Mackey, Portland, Ind., division surgeon G. R. & I.

Dr. A. O. Williams, Ottumwa, Ia., local surgeon C., R. I. & Pac.

Dr. H. E. Davenport, Sheridan, Ind., local surgeon C., I. & L.

Dr. A. A. Woodford, Belington, W. Va., local surgeon B. & O.

Dr. L. A. Bishop, Fond du Lac, Wis., local surgeon C. & N. W.

Dr. J. C. Chipman, Sterling, Colo., assistant surgeon N. Pac.

Dr. William S. Allee, Olean, Mo., local surgeon M.

Pac.

Dr. W. D. Williamson, Portland, Me., local surgeon G. T.

Dr. James T. Jelks, Hot Springs, Ark., consulting surgeon M. Pac.

Dr. Walter B. Stewart, Joliet, Ill., local surgeon E. J. & E.

Dr. T. D. Baird, Walsenburg, Colo., local surgeon C. & S.

Dr. O. O. Cooper, Hinton, W. Va., local surgeon C. & O.

Dr. J. C. Wysor, Clifton Forge, Va., surgeon in charge C. & O. Hospital.

Dr. John B. Trowbridge, Hayward, Wis., local surgeon C., St. P., M. & O.

Dr. Frank E. Whitley, Webster City, Ia., local surgeon C. & N. W.

Dr. John Fay, Altoona, Pa., surgeon Penna.

Dr. Joseph E. Luce, Chilton, Wis., local surgeon C., M. & St. P.

Dr. F. F. Davis, Oil City, Pa., surgeon Penna. Dr. Samuel Bell, Beloit, Wis., local surgeon C., M. & St. P. and C. & N. W.

Dr. Charles V. Artz, Hastings, Neb., assistant surgeon B. & M. and F., E. & M. V.

Dr. Albert F. Merrell, Hallstead, Pa., local surgeon Lackawanna.

Dr. Walter P. Hailey, Wilburton, Ind. Ter., local surgeon, C., R. I. & Pac.

Dr. John P. Webster, Chicago, Ill., chief surgeon C. & W. I., local surgeon Monon and Erie.

Dr. W. H. Banwell, Orleans, Neb., local surgeon B. & M.

Dr. Bacon Saunders, Ft. Worth, Tex., chief surgeon Ft. W. & D.

Dr. F. K. Ainsworth, Los Angeles, Cal., division surgeon S. Pac.

Dr. C. F. Smith, Kankakee, Ill., division surgeon C., C., C. & St. L.

Dr. W. Courtney, Brainerd, Minn., chief surgeon N.

Pac.

Dr. C. A. Wheaton, St. Paul, Minn., chief surgeon St. P. & D.

Dr. H. McHatron, Macon, Ga., local surgeon Southern. Dr. J. W. Freeman, Lead, S. D., local surgeon F. E. & M. V

Dr. A. H. Bernstein, Scranton, Pa., surgeon Erie. Dr. A. E. Early, Kingman, Ariz., local surgeon S. F. Pac.

Dr. Southgate Leigh, Norfolk, Va., surgeon N. & W. Dr. J. D. Justice, Quincy, Ill., ex-surgeon M. Pac. Dr. D. S. Middleton, Rising Fawn, Ga., local surgeon A. G. S.

Dr. W. S. Huselton, Pittsburg, Pa., chief surgeon P. & W.

Dr. H. Hapeman, Minden, Neb., local city K. C. & O. Dr. J. Dennett, Jr., Congress, Ariz., local surgeon S. F. Dr. John H. Miller, Pana, Ill., local surgeon Big Four and B. & O. S. W.

Dr. Ferdinand J. Smith, Alton, Ia., district surgeon C. & N. W.; local surgeon C., St. P., M. & O.

Dr. E. S. Moore, Bay Shore, N. Y., local surgeon L. I. Dr. G. J. Rivard, Assumption, Ill., local surgeon I. C. Dr. Archer C. Jacobs, Elmore, Minn., local surgeon C. & N. W. and C., St. P., M. & O.

Dr. J. M. Weaver, Dayton, O., local surgeon Big Four. Dr. Theodore P. Livingston, Plattsmouth, Neb., medical director B. & M. R.

Dr. W. W. Essick, Murphysboro, Ill., surgeon M. & O. Dr. David La Count, Wausau, Wis., local surgeon C. & N. W.

Dr. M. A. Koogler, El Dorado, Kan., local surgeon M. Pac.

Dr. J. A. Geisendorfer, The Dalles, Ore., railway physician O. R. N. Co.

Dr. Asa B. Bowers, Maquoketa, Ia., local surgeon C. & N. W.

Dr. John A. Ritchey, Oil City, Pa., surgeon Penna. and Erie.

Dr. William F. Freeman, Needles, Cal., division surgeon S. F. Pac.

Dr. William Wakefield, Lake Benton, Minn., local surgeon C. & N. W.

Dr. Allan Cameron, Owen Sound, Can., local surgeon C. Pac.

Dr. John E. Musgrave, Handley, W. Va., surgeon C. & O.

Dr. Marion S. Gressett, Branchville, S. C., surgeon Southern.

Dr. A. C. Wedge, Albert Lea, Minn., local surgeon C., M. & St. P.

Dr. C. Holtzden, Chattanooga, Tenn., surgeon N. C. & St. L. and W. & A.

Dr. Albert P. Jackson, Oakfield, N. Y., local surgeon N. Y. C & H. R.

Dr. E. O'Neill Kane, Kane, Pa., local surgeon P. & E. and B., B. & K.

Dr. S. R. Miller, Knoxville, Tenn., surgeon Southern; division surgeon A., K. & N.

Dr. J. B. Murphy, Chicago, Ill., chief surgeon W. C. Dr. C. W. More, Eveleth, Minn., surgeon D., M. & N. and D. & I. R

Dr. A. Miner Straight, Bradford, Pa., surgeon B., R. & P.

Dr. Charles F. Warner, Mankato, Minn., local surgeon C. & N. W.; C., M. & St. P.; C., St. P., M. & O. Dr. Frank Fitzgerald, Morrison, Ill., local surgeon C. & Y. W.

Dr. Paul Y. Tupper, St. Louis, Mo., company surgeon C., B. & Q.

Dr. W. W. Hamilton, Brooksville, Miss., local surgeon M. & O.

Dr. James Lindsay, Guelph, Can., local surgeon C.

Pac.

Dr. Arthur T. Kemper, Muncie, Ind., local surgeon Big Four and L. E. & W.

Railway Surgeon

Monthly Journal of Traumatic Surgery

than twice the number now reported for one-quarter of a

year.

"An examination of the reports of individual cases in this class of accidents shows that an appreciable percentage is made up of cases occurring in what may be called emergency work, such as coupling to a car which

Published by The Railway Age and Northwestern Railroader (Incorp'd) has just been in a slight accident, and on account of

MONADNOCK BLOCK, CHICAGO, ILL.

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By an act of Congress passed March 3, 1901, monthly reports of collisions and derailments and of accidents of all kinds, causing injury, fatal or otherwise, to passengers or to employes on duty, are required to be made to the Interstate Commerce Commission. They are published by the latter in the form of "Accident Bulletins," numbers 1 and 2 for the last six months of 1901 being now available. No reports are required of trivial accidents, of casualties at crossings, or to persons walking on the track, nor to employes who are not on duty.

The number of persons killed in June, July and August in collisions, derailments and miscellaneous train accidents was 240, and of injured, 2,622. Other accidents, such as those to employes at work and passengers getting on or off cars run the total up to 11,212 (725 killed and 10,487 injured).

Regarding "coupler accidents" the report states: "The diminution in "coupler accidents," due to the general use of automatic couplers, may be roughly measured by comparing the present record for three months with one-fourth of the total for one year as shown in former reports. For the year ending June 30, 1900, the Commission reported 282 employes killed in coupling and uncoupling. One-fourth of this number, 702, is more

which the automatic coupler has been taken off the car or is out of order. Such irregular work is practically unavoidable, and the injury record, to the extent that it is produced by cases of this kind, is not to be taken as showing anything to the discredit of either the automatic coupler or the men doing the work.

"Another point noticeable in the individual reports is the occurrence of accidents to men who have been only a few months in the service. The cases in which the report says that the injured man has been a brakeman or switchman for less than one year are not, perhaps, to be called numerous, yet their frequent recurrence suggests the need of a period of carefully managed apprenticeship for the proper training of a brakeman. That a considerable percentage of injuries in this class is due to some defect in the coupler is a matter of common knowledge.

"This point was alluded to in the fifteenth annual report of the Commission to Congress. These defects are often very slight, and many of them are due to lack of intelligent care, rather than to faults of material or design. A good share of them are to be classed as unpreventable except by the gradual improvement in design of parts and by added experience on the part of the men. This, of course, means that trainmen should exercise particular care for their own safety when any coupler or coupler attachment is in the slightest degree out of order."

For the last three months the number of persons killed in accidents was 272, and of injured, 2,089. Accidents of other kinds bring the number up to 11,048 (813 killed and 10,235 injured).

In commenting on the reports turned in by the companies, the Bulletin states:

"It is to be observed that in most cases the brief sentences giving the causes of these collisions do not by any means afford a satisfactory explanation of the precise. circumstances which resulted in the accident. The law requires the companies to report the causes of collisions. and the circumstances accompanying each. This requirement, however, is not very well complied with; that is to say, in a case of negligence-nearly all collisions are due to negligence-the manager seems to be satisfied with a statement, for example, that a telegraph operator failed to deliver a meeting order; or that a conductor, in consulting the time-table schedule of a superior train, made the mistake of reading the wrong column, or overlooked a word or figure; or again, a statement showing that an engineman forgot that a certain order had been delivered to him, but not showing whether or not the conductor of the train, equally responsible with the engineman, did or neglected to do anything to check or correct the engineman. The simplest error may produce the greatest disaster. The first step, therefore, in any movement looking to the reduction of the railroad accident record which record may not unfairly be characterized as a reproach to the country-is to learn and state

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A patient, fifty-one years of age, of good personal and family history, was admitted to the State Hospital in 1899, with a history of convulsions and mental disturbance following an injury on the top of his head eight months before.

After this traumatism he suffered from considerable headache. Twenty-eight days later he had a convulsion. Later, he developed restlessness and confusion, sometimes mental depression. The epilepsy persisted, a stuporous condition developed, and death ensued.

Autopsy showed a recent hemorrhage in the right hemisphere as the cause of death. There were symmetrical areas of softening at the base of the brain in just the position where a blow on the head would act by contre-coup. Arterio-sclerosis of the brain was present. The convulsions and mental symptoms were directly due to the lesions of the base of the brain.

He sums up as follows:

1. Violence inflicted upon the skull frequently results in small lesions upon the base of the frontal lobes, at the apices of the parietal or occipital lobes. At these areas destruction of the tissues is shown by hemorrhagic infiltration of the tissue and all stages of eucephalitis. From these foci of destruction later appear scars and other defects with cicatricial investment.

2. The presence of such scars may be taken as an indication of previously sustained trauma. Diminutive cicatrices with numerous areas of hemorrhage may be assumed to be of traumatic origin. They appear as small contractions or depressions.

3. The excluded blood may be entirely reabsorbed or remain in the form of pigment deposits, or of colored amorphous masses.

4. Rigidity of the neck and forced positions of the body indicate meningitis and suggest lesions of the base of the brain.

5. Coma and spasm, followed by death, may appear suddenly in traumatic cases from minute areas of destruction of vocal cortex.

6. Symptoms of sudden irritation of the brain and of general mental degeneration may develop after injuries to the head have shown few symptoms at the time.

7. The brain may be injured by an accident affecting the buttocks or extremities.

8. Dementia post-traumatic may be distinguished clinically, though often with difficulty, from dementia paralytica.

9. Universal changes in the blood vessels occur in such cases of traumatism.-Medical Review of Reviews.

Translations.

RHYTHMIC SUBLUXATION OF THE LOWER JAW AS AN AID IN CHLOROFORM NARCOSIS.

[Translated for The Railway Sur, eon.]

As chloroformization and its accidents are attracting considerable attention at the present time, it seems of interest to point out a simple and practical method of preventing syncope. It has been used in over one thousand cases of narcosis without any warning of danger.

The method about to be described is not intended to supplant any of the methods in daily use, but should rather be considered as a supplementary maneuver to the classic method of small and continuous dosage.

The patient being in the dorsal decubitus, the head level and the trunk supported on one or more blankets, the chloroform is dropped on the compress at regular intervals until the stage of excitement. In the intervals between the chloroform the lower jaw is energetically lifted up by the fingers applied on the posterior border of the descending ramus, near the angle of the bone. This precaution alone will not suffice to prevent the use of the tongue forceps or to insure against accidents.

Hence from the stage of excitement the anesthetic is dropped more frequently, and in the interval between one drop of chloroform and the next the jaw is given rhythmic movements up and forward. This is more easily accomplished as muscular relaxation becomes more complete. These movements bring on equally periodic movements of the suspensory apparatus of the tongue and keep the pharyngeal reflex vigorous enough to suffice for respiration. Their principal advantage, then, will be to assure the regularity of the inspiratory mechanism, in spite of the precipitation of the doses of chloroform. Another real advantage is that they facilitate to a large extent the expulsion of the mucus which so often obstructs the upper air passages, especially in smokers and alcoholics.

During the whole operation the patient is kept so as to have a slight palpebral reflex, on the point of disappearance. This degree of anesthesia, sufficient for the most painful operations, being obtained, the interval between the doses of chloroform is slightly lengthened, without neglecting to make these rhythmic movements of the jaw between each dose. If this method is followed it will not be necessary to make traction on the tongue, for the patient never reaches the stage of asphyxia to warrant it. Tongue forceps will be called for only in exceptional cases of certain operations on the face. Even in these cases the rhythmic subluxations will be of great assistance to the anesthetist.

The details of chloroform anesthesia can be found in the text-books, but there is one complication to be watched for. This is in cases of superficial keratitis, which almost completely abolish the palpebral reflex. What is to be done then? The cremasteric reflex is at some distance; the pulse is difficult to follow, because it is essential in this method to not abandon the lower jaw. A good method of following the narcosis is to note the movements of the thorax and abdomen, or, still better, the

force of the expirations. This may be appreciated very exactly by the dorsum of the hand with a little practice. If one hand is thinly coated with ether (a device well known to mariners) the slightest breathing can be perceived.-La Revue Medicale.

CASE OF COLLATERAL CIRCULATION AFTER TEARING OF BOTH RADIAL AND ULNAR ARTERIES.

BY WILLIAM J. KRESS, M. D., of St. Louis.

L. B., male, aged forty years; injured August 31, 1900, while operating a leather stamping machine. His left forearm was badly crushed, completely lacerating all the flexor muscles and tearing out their bellies, severing all tendons as well as both the radial and ulnar arteries. The entire lower third of the radius was crushed into several small pieces which it was necessary to remove. The radius was also fractured at the junction of the upper and middle thirds.

After consultation with Dr. Bernard S. Simpson, who was called to assist me, it was decided to wait for gangrene and its line of demarcation to point out the extent of tissue to be removed. The radial and ulnar arteries were ligated and all tendons taken up and sewed into their anatomical relations. A bichloride pack, I to 2,000, and splints were applied. The patient's temperature on the following day was 99 1-5 degrees, gradually rising each day until it reached 101 degrees, which point it never exceeded. The patient's general condition remained good; he was cheerful and suffered very little except when the dressings were changed each morning. Fourteen days after the injury a well-defined line of demarcation became apparent at the index, middle and ring fingers close to the carpo-phalangeal articulations, and the line also showed on the little finger at the last phalanx.

All fingers were amputated in healthy tissue just above the line of demarcation. The parts healed slowly by granulation and there was very little sloughing, leaving the hand healthy as well as the thumb and little finger. The blood supply to the little finger, thumb and the rest of the metacarpus must have been supplied through the interosseous arteries, because the main trunks were both cut.

The patient has regained motion in the thumb and little finger and in the wrist. I had been advised by several prominent physicians to amputate well up on the forearm on the day of the injury, but declined to do so. The collateral circulation was completely established and a useful hand remains. This case again illustrates in a striking manner that early amputation on the hand and forearm is a practice to be avoided. I believe we cannot be too conservative in the practice of surgery when the hand or fingers are involved. The danger of septic absorption is reduced to a minimum by the moist antiseptic dressing.-Interstate Med. Jour.

Tuberculosis is the commonest and most important affection of the cervical glands, and may occur in any of the glands, but is more common in the anterior triangle; the irritation producing the enlargement of the gland or the point of entrance of the bacilli is undoubtedly most frequently in the mouth or throat.-Cheyne and Burghard.

First Aid and Emergency.

(Conducted by CHARLES R. DICKSON, M. D., Toronto, Can.)

FIRST AID ON THE RAILWAYS.

Through the courtesy of a number of railway officials, the methods adopted by some of the railways of America in dealing with the First-Aid problem, together with descriptions of emergency packets and boxes in use, and other allied items of interest, are available for instruction, comparison and emulation. They will be published in this column from time to time as opportunity permits.

CANADIAN PACIFIC RAILWAY COMPANY. Western Division, Chief Surgeon's Office, Winnipeg, Man.

General Superintendent Leonard has handed me your letter, asking for information re "first-aid to injured” on our line. We have not adopted any general system of instruction in first-aid among the employes. At Winnipeg, which is the most important center on the division, we have many years ago given some demonstrations, and we have fairly competent men in the shops and yard who are supplied with emergency boxes. The contents of these boxes have varied a good deal from time to time during the last ten years or more, so that the directions are hardly up to date.

Box contains: Carbolic acid, brandy, towels and rubber cord, bandages, triangles, etc., antiseptic gauze, iodoform, scissors.

Carbolic lotion: To make carbolic lotion stir large tablespoonful of carbolic acid in a pint of hot water.

Shock: In cases of serious injury a man may be unconscious, faint from loss of blood, or excessively weak from shock. Under these circumstances he should never be for a moment pulled into a sitting posture, but should lie flat on his back, or, if on board or stretcher, the foot of the same may be raised so as to lower the head still more. Clothing about the neck should be loosened. Hot cloths may be applied over the heart and if he can swallow and is not bleeding a glass or two of brandy in water may be slowly administered.

Treatment of injury: Expose at once the injured part by cutting off clothes and loosen tight bands about it. Railway wounds are usually lacerated, and lacerated wounds seldom bleed too much. If bleeding freely apply at once grm pressure on main artery of limb (see diagram) or on the bleeding part. This may be easily continued while he is being carried by others to a convenient warm place.

When the limb is fractured handle carefully and keep it in line. If after ten or fifteen minutes there is no more bleeding on removal of pressure, cover the wound area with towels or cotton waste wrung out of carbolic lotion, secure with handkerchief or bandage and place the limb on padded splint or pillow or small folded blanket. When this pressure fails to stop bleeding in the limb apply folded towel around it between wound and the heart and remain continuously on the limb more than one hour at a over this pull tightly the rubber cord. This cord must not

time. It must be removed at intervals, and if still necessary to check bleeding, pressure applied with fingers, as

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