220 WITH BOAT AND GUN IN THE YANGTZE VALLEY. 



probably be the first things brought into use, and afterwards a pad of salicylic cotton 

 or clean rag, wetted when possible with the carbolic solution and held in position by 

 a firmly applied bandage. Direct pressure will stop all venous or capillary bleeding, 

 and may even be depended on to check haemorrhage from a small artery. Bleeding 

 from a large artery, when red blood jets or wells up rapidly from a deep wound, may 

 be stopped by a plug of cotton firmly packed into the wound, but may need in addition 

 pressure applied by some form of tourniquet between the wound and the heart. A 

 handkerchief knotted round the limb where the wound is with leg or arm, and twisted 

 up with a short stick, makes a good tourniquet, and the materials are always at hand. 

 In bleeding from the arm or leg remember always to raise the limb up to or above the 

 level of the body. 



Sprains are best treated from the first by firm elastic pressure made by binding a large 

 mass of cotton round the injured joint ; the salicylic cotton should not be used for 

 this purpose, as in rendering it absorbent it has been deprived of a good deal of its 

 elasticity. The cotton which can be obtained in every village in the neighbourhood 

 of Shanghai is a suitable cotton to use in treating sprains. In applying it be careful 

 to use a sufficiently large quantity — you can scarcely use too much — and see that the 

 bandages are firmly and evenly applied. At least two bandages will be needed for 

 any of the large joints; and if it is the knee or the elbow, in addition to the bandages 

 which secure and compress the cotton, the limb should be bandaged from the fingers 

 or the toes upwards to prevent swelling. 



Fractures and Dislocations.— A good deal is usually said in books on "first aid" 

 about the signs which distinguish fractures from dislocations, but it may comfort the 

 amateur to know that the surgeon may himself be puzzled when a fracture occurs in 

 the immediate neighbourhood of a joint. Moderate steady traction in the axis of the 

 limb will usually, but of course by no means always, decide the question between 

 fracture and dislocation. If the case is one of fracture the deformity will disappear, 

 only to return however in a greater or lesser degree when the traction is relaxed. A 

 dislocation is not so easily dealt with; in these injuries the limb is more or less fixed 

 in its unnatural position, and deformity will not disappear until the dislocated bone 

 has been returned to its socket. The grating produced by the rubbing together of 

 the ends of a broken bone, technically called crepitus, is a sign of fracture which if 

 distinctly elicited can be depended on ; but in trying to obtain such a proof the 

 amateur must carefully avoid all rough handling of the limb. The sooner a fracture, 

 or a doubtful case, is put up in splints the better. No man with a broken leg should 

 be moved from the ground where the accident has occurred until splints have been 

 applied. A simple fracture, when the skin is unbroken, is an injury attended with 

 little risk ; but a compound fracture, where the soft parts are torn and the ends of the 

 broken bone exposed, is a very serious accident. Wounds over broken bones should 

 be thoroughly washed with solution "A" and very carefully dressed. A simple 

 fracture, especially a fracture involving bones which lie immediately under the skin 

 as the bones of the leg, may easily be converted into a compound fracture by 

 ill-directed efforts made to lift the patient or to remove clothing. 



