Dupuytren ligatured the femoral several times for bleeding from the calf, but with what result it is impossible always to make out. S. Cooper, while he once successfully took up the popliteal for secondary haemorrhage from a wound of the posterior tibial, strongly reprehends the practice as a general rule. F!;>.M WOTNDS. and inwards through the left leg, on the 18th of June. Tinfibula was bn>km, and the of tintibia was injure 1. w.dke 1 to the rear without assistance. On admission into the hospital, the limb was greatly swollen. This swelling, by appropriate means, very inueh diminished in a tew days. the fifth day arterial bleeding. to & limited extent, took place, from both openings. lling a case put on record by Mr.
Butcher of Dublin, of a wound of the post tibial, I determined on trying the effects of well-applied pressure along the course of the popliteal, and in the wound, combined with cold and elevation. The limb was also fixed on a splint. The object of the pressure on the main vessel was to diminish, not arrest, th tl.w of blood through it. On tin- eighth day there was again some oozing. Pus had accumulated among the muscles of the calf, and required -ion for it On the ninth day a pulsating ur was observed on the external aspect of the " the consecutive false aneurism " of Foubert, and day ill returned from both wounds. 1 wished then to cut down and tie the vessel in the wound, but a consultation decided on waiting a little longer. in hope that the bleeding might not return.
On the night;!i day most profuse reeiinvd. The attendant, though strictly enjoined to tighten the tourniipiet, failerl to do so, but the nece. ps to taken by the oflicer on duty. Next morning, when I first heard of the oeeurrence, I found t'i. I blanched, cold, and nearly consultation decided that ihe state of the pari< D til-"f t!i-ri.' wound as the liml, woiil.l not recover if the main artery was taken up, amputation must be performed so soon as the patient had rallied. When reaction had fairly taken place, I amputated the limb. The removed parts wore much engorged, sloughed, and disorganized. The anterior tibial was found to have been opened for about an inch shortly after its origin, and on it was formed the aneurism, which had a communication with both orifices of the wound.
In all such cases the second bleeding should determine active interference. I say the second bleeding, as it very often happens, that when haemorrhage has taken place once, even to a considerable extent, and evidently from a vessel of large calibre, it never recurs. Many most striking instances of this have come under my notice. But though more than even this is true, and that frequently blood thrown put repeatedly is spontaneously arrested, still the great preponderance of cases, in which it recurs in dangerous repetitions and quantities, as in the above instance, should cause us, I believe, to interfere on its second appearance, more particularly if the bleeding be in any quantity. Not to interfere unless the vessel is bleeding, must not always be understood too literally, or we will often be prevented from performing the operation till our patient is beyond our help.
The haemorrhage recurs over and over again, and the surgeon, though as near as is practicable, arrives only in time to see the bed drenched, and the patient and attendant intensely alarmed. There is at the moment no bleeding, and he vainly hopes there will be no return; and so on goes the game between ebbing life and menacing death, the loss not great at each time, but mighty in its sum, till all assistance is useless. Many a valuable life has II.M GUN-SHOT WOUNDS. ri which mi-lit have been saved by a more led course of art 'mi i. lg than these to tin surgeon, or require nioiv determination, and well-consiion to conduct to a successful issue. One to act when the immediate necessity has passed; led in our course by a knowledge of general results, more than by the immediate ease in. we will l>~ I patient.