The subclavian artery passes next into the arm-pit, and, here again, the pulse can be felt when the clothing is removed. Leaving the arm-pit, the artery takes a half-turn over the bone of the arm to reach the inner or flexure side of the elbow joint. By grasping the arm firmly from back to front, so that the fingers press along the inner edge of the biceps muscle, the pulse can be again arrested (see illustration).

Control of bleeding below the elbow by pressure on the brachial artery

The next point is on the inner side of the elbow joint. There the artery divides into two vessels of equal size, which pass down the forearm, lying close to the bones of the forearm and well protected by the surrounding muscle.

At either side of the wrist the arteries are near the surface, and this is the point which is most conveniently utilised for testing the action of the heart by " feeling the pulse." The artery on the little finger side passes to the front of the wrist and runs along the " line of life " at the ball of the thumb. The other passes to the back of the wrist and is placed deeply between the thumb and forefinger to reach the palm of the hand. In the palm both arteries form arches from which branches continue forward along the sides of the fingers where they are best protected.

The common carotids lie on either side of the windpipe until they reach the skull, and their pulsation may be felt by light digital pressure against the windpipe. Each vessel crosses the lower jaw, a little in front of the angle of the jaw, whence it sends branches to the chin, lips, nose, and cheek. The temporal artery may be felt in front of the upper part of the ear, while the occipital artery is as plainly felt four fingers' breadth behind the ear

Following the aorta downwards, it is known as the thoracic and abdominal aorta as it passes through those parts of the trunk respectively.

Control of the subclavian artery

About halfway down the abdomen it divides into two. One branch is known as the internal iliac, and supplies the organs situated in the pelvis. The other, the external iliac, divides and enters the lower limbs exactly at the centre of the top of the thigh, known as the fold of the groin." As each branch enters the thigh it comes near the surface, and its pulse may be casily felt. The artery of the thigh passes downwards and inwards towards the flexure side of the knee, and, although well protected by its position, it is liable to accidents, which if not attended to with great promptitude may cause a speedy death.

Behind the knee pulsation is again noticeable, but at this point the artery divides into two branches, which lie deeply embedded between the two bones of the leg. The two vessels pass over the ankle, and pulsation may be felt at the bend of the foot and also just below the projecting bone on the inner side of the ankle.

Tourniquet on thigh to control femoral artery

The course of the vessels through the foot is not important, as pressure must be exerted at one or both of the points at the ankle already mentioned.

We are now in a position to understand how; to arrest arterial bleeding. The general rule is to apply pressure on a pressure point between the injury and the heart, but as far away from the heart as possible, so as not to cause more extensive numbness than absolutely necessary. The pressure must be exerted at a pressure point - i.e., where an artery, coming near the surface, has a bone behind it against which it can be pressed.

Digital compression should be applied at once. The great drawback is that such pressure cannot be long sustained, and relief from other helpers is not always possible. The same kind of pressure can be obtained from a tourniquet, which can be extemporised from homely articles to do the work of the elaborate instruments employed by surgeons. Such instruments consist essentially of a strap round the limb, a pad to press on the artery, and a screw to tighten the strap so that the pad presses further and deeper on to the artery.

A pad may be extemporised from any hard substance, such as a purse, a cork, a lump of wood, a stone, or piece of coal wrapped in a handkerchief; the strap consists of a triangular bandage or its substitute, as described in Article I.; and the screw is nothing more than a stick of wood, an umbrella, key, pencil, bayonet, policeman's truncheon, or any similar rodj tied in the knot of the bandage opposite the pad and twisted round and round until the pad presses sufficiently hard to prevent the flow of blood through the artery.

The tourniquet must remain pressing on the artery until medical assistance arrives,, but in case of long delay the screw may be fattened a little at the end of an hour, and, if no bleeding occurs, may remain slack, but it must be, promptly re-screwed at the first return of haemorrhag

Briefly, the control of arterial bleeding may be detailed as follows:

For bleeding in the palm of the hand: Apply a cone-shaped pad point downward the wound, bend the fingers over to press it, bandage them tightly with]a narrow bandage, and put the arm in a wide sling with the hand high.

For bleeding from other parts of the hand: Put a hard pad on each side of the front of the wrist, and bandage them firmly in position.

For a wound in the forearm: Place a hard pad in the bend of the elbow, bend up the forearm, and bandage it as shown for leg.

For bleeding in the armpit: Control the subclavian artery, push a hard pad sufficient to fill the armpit against the wound, bind the arm tightly against the side, and put the forearm in a large arm-sling.

The brachial, artery must be controlled before attending to wounds in the lower arm, forearm, or hand. For bleeding in the lower limbs:

From the sole of the foot: Control the circulation at the ankle. Apply a conical pad on the wound, and bandage it tightly.

From the leg: Apply a hard pad, well pressed into the hollow behind the knee; bend the leg and.bandage it.

From the thigh: Control the circulation by pressure on the artery at the fold of the groin; apply a tourniquet to the artery of the thigh.

For bleeding from the head and neck:

From the temple, front, or top of head: Compress the temporal artery by a hard pad, retained in position by a narrow folded triangular bandage crossed opposite the pad.

From the face below the eyes: Compress the artery that passes over the edge of lower jaw, apply a hard pad, as above.

From the neck: Apply digital compression to the carotid artery, and, when the bleeding has stopped, dress the wound, bend the head forward, and fix it in position with bandage.

Leg flexed and tied to control arterial bleeding below the knee