A shell passed between a man's thighs, and, destroying the soft parts, divided both femorals; yet there was no haemorrhage, although the pulsation continued in the upper ends of the vessels to within a few lines of their extremities. The speed of the ball at the moment when it comes in contact with an artery has a good deal to do with the injury it inflicts. If it be in full flight it may so cut open the vessel as to allow of instantaneous haemorrhage; whereas, if its speed be much diminished, the contusion it occasions opposes immediate, but favours secondary bleeding. Primary hemorrhage may take place either HMM GKJN-6H0I WOUNDS. '' on the receipt of a wound, or after a little time, when the taintness resulting from the accident has gone ntr.
I have air to some instances in which the former is liable to occur. In wounds of the face, too, this instantaneous bleeding is very usual. Some cases occurred in tin- Crimea of the well-known. that limbs may be carried away, and their arteries Looaelj innii the shattered stump without bleeding. mder my own notice, in which legs were carri by round shot, and no haemorrhage took place, though both men died subsequently from other s. This spontaneous cessation of haemorrhage is ps most commonly seen in the upper to inform us of the number of > eith tely or proportionately to the whole number <>f in which secondary luemorrhage took place duri IT. Although 1 have no figures to which can refer as corroborating the si 1 am inclined ink that the proportion of cases in which serious bleeding did take placv. is h!;;hi T than that set down by!Mr. ( iuthrir.
Th.distinction drawn by I>r. John tween secondary ha-inorrhauv, proecedin-from sloughii.tin, and cxeitcil arterial action as it occurs vnt stages of treatment, is a good one. That which takes plaur hours and Up to th- truth day i due to slnu-'hinir, result in-' din-the injury, should always have the term 4 ' int'Tiii'-diary " apjili.-d to it: and the bleeding which proceeds from morbid action, such as ulceration attacking tin- part, and win;-lacc at a later period, would be more appropriately call,,1 " par excellence" second Haemorrhage should thus be into three I- AN WAR. periods: " primary," occurring within twenty-four hours; "intermediary," between that and the tenth day; and "secondary," that which takes place at a later date.
More precision would be given to our language on this important subject, by such a distinction being always recognized. The period at which consecutive bleeding is most apt to take place has been variously estimated. Guthrie sets it down as occurring from the eighth to the twentieth day, Dupuytren from the tenth to the twentieth, Henman from the fifth to eleventh, and Koux from the sixth to the twentieth. In the cases I have myself observed, it has taken place between the fifth and twenty-fifth days, and by a curious coincidence, it has appeared in the majority on the fifteenth after the receipt of the wound. In one case, a wound without fracture of the thigh, it was said to have taken place as late as the seventh week, and that when no gangrene or apparent ulceration was present.