Consecutive haemorrhage may occur from very insignificant vessels, and be arrested by simple means; but when it takes place from a large arterial trunk, it is an accident of the most serious With us, in particular, such effusions were causes of extreme anxiety, The following is a very interesting case of secondary haemorrhage. caused by the limited ulceration of a large artery, which is related by Dr. Scott of the 32nd, in a report existing in the archives of the medical department: " Private John Hodgson, aged 31, was struck by a ball at Mooltan, about a line anterior to the left carotid artery, below where it divides into the external and internal, and passing through the oesophagus, escaped at a point corresponding to its entrance.
No unfavourable symptom appeared for nine days, when a fit of coughing came on, and blood issued from both the mouth and the wounds, and the patient instantly expin-d.: I AUK n;M til N-SIIOT WOUNDS. itatti of tlic health of our patients made such an accident peculiarly disastrous. Their strength could not withstand such a drain, and the scurvv made their Mood so thin and effusible that they liable to. blood, not by vigorous ha-innrrhaires, but by slow, though not less destructive, in this it can be understood that in the Crimea many of the time-honoured remedies for haemor;.-, such; ctionj were entirely irded. and replaced most generally liy their Tunics, as quinine and iron, were the remedies most wanted; and as to styptics given internally, they always appeared to me to be mere farces, except in so far as they a general tonics.
The more useful prophylactics to such consecutive such as quiet of mind, and perfect rest of th be executed at d period they become most dangerous. No man, at all severely wounded by trim-shot, eun be considered safe from ha-iimn-haire till his wound is closed, but yet. after tuvnt e days, the danger may he said to be in a great inrasure overcome. In reference to this has an advantage over an opm campaign, ixedness of the hospitals, and the less tent irotid had been grazed at its bifurcation, and a piece of it about of a small pea, an<l in. all its coat, had sphacelated, and, giving way, caused death before aiaistance could be got." Hsemorrhairi 1 occurring early was universally treated by the rule laid clown by Bell and Guthrie, of tying both ends of the bleeding vessel.
When, however, the bleeding appears at a late date, when the limb is much swollen, its tissues infiltrated, matted together, and disorganized, it is by no means an easy thing to follow this practice. The difficulty is perhaps greatest in calf of the leg, where the muscles are much developed, when the posterior tibial has repeatedly "bled, the wound large and irregular, the contusion severe, and the blood welling out from among the disorganized tissues in no collected stream. The rules and precepts laid down in books about the appearance of the vessel and the orifice, about the mode of passing a probe towards it from the surface, and the best way of cutting so as to fall upon the vessel, are all worse than useless; as they lead us to expect guides where there are none, but those which watchful eyes and careful incisions afford From the results of several cases which fell under rny observation in the East, I have reason to believe in the soundness of the views lately put forth by Nelaton, in opposition to the long-credited opinion of Dupuytren, as to the unsound state of the artery in suppurating wounds.
I feel pretty sure that the vessel will, in most cases, bear a ligature for a sufficient time to fulfil the end we have in view in its application. It will be necessary to attach it with caution, to employ no more force than is absolutely necessary, and we may expect it to separate, as Nelaton shows, before the usual time, yet it will continue attached sufficiently long to close tinvessel, if we do not keep pulling at it so as to tear it DS, iiroly. It r mall force illsc.;:i!-l that the vessel will COminonly st al i,l. hand' the liirature at t: t' injury in primary perform inn when the l>leedii!;r appears illegible in the scan of the first