TOUENIQUET. 683 



wound mad© on the limb at a spot below the tourniquet. The 

 occurrence of this bleeding can be almost entirely prevented, by 

 the previous application of an Esmarch bandage, which consists 

 of a thin india-rubber band about 2J inches broad and 8^ feet 

 long. It is rolled tightly round the leg, from below upwards ; 

 beginning at the pastern and ending just above the knee (Fig. 

 176). A tourniquet is then put on immediately above the band- 

 age, which is taken off, by undoing it from below upwards. The 

 application of this bandage drives away the blood, which is pre- 

 vented from returning, by the tourniquet; the result being that 

 the part below the tourniquet becomes comparatively bloodless. 



Fig. 174. — Arnold's Reliance Tourniquet. 



If the operation has to be performed higher up the limb, the 

 bandaging can be continued by the use of a second bandage of 

 the same kind. Although a bloodless condition of the part may 

 appear at first glance to be a great advantage, especially to an 

 inexperienced operator, " it has serious drawbacks, when the 

 wound has to be made in a part which, contains numerous and 

 important blood vessels, because it greatly increases the difficulty 

 of distinguishing arteries, veins, and nerves from each other. 

 The operator is sometimes obliged to remove the tourniquet, 

 in order to re-establish the circulation of blood, so that he may 

 be able to find out the exact situation of the arteries, or to see 

 what small arteries have been cut. Also, the use of a tourniquet 

 and Esmarch bandage is apt to give rise to extensive bleeding 



