These cases form an exception to the rational prescribes inaction, unless there be immediate call for interference. There can he little doubt that haemorrhage definitely arrested by pressure applied extensive part of the wounded artei well as to tli- apertures; but such treatment is not adapted for gun-shot wounds, from the depth and narrowness of their tracks, unless we so enlarge them.is to admit the, compress deep into the wound. This was shown in the case recorded ab< in many others. The is pent up by the. pln.v;, and burrows largely -ues. Th many cases of from the hand 8UCC!i.,t wounds, which came under my of the injuries resulted the, acci ion of the patient's own irun. and, I suspect,!
Lees from intention, Ha-mon! in V ' times very troublesome, espev when the bones of the hand weiv much fractured, as it was then dillicult, if not im Vessel in the woiin-l. The secondary bleeding usually appe -<; cases, and, so far u my obi lirachial seems better pr. when local means fail, than putting a thread on the vessels of the forearm, as I saw done several times in the East. In recent cases we can often ligature the bleeding vessel, but in the sloughing stage, with a deep wound, and the bones much injured, it is impossible to secure it. To ligature the radial and ulnar separately, or conjointly, exposes the patient to operative dangers which bring no adequate return, as the probability of success is very small.
In the following case, the ligature of the vessels of the forearm succeeded; but in four other cases, in which I knew it tried for wounds of the palm, it failed utterly. The position of the wound in this case made it more likely that the proceeding followed should succeed: A soldier, resting his right hand on his musket, was struck by a ball on the web between the thumb and forefinger. The wound seemed trivial, but the whole hand swelled exceedingly. On the fourteenth day arterial haemorrhage occurred, and pressure was applied. The bleeding repeatedly recurred, and still pressure was persevered in. Finally, the radial, and then the ulnar, were ligatured before the haemorrhage was commanded. An early search in the wound, would probably have succeeded in securing the vessel.
I have seen the method of pressure on the brachial by flexing the arm, and by bandaging; both fail in some of these cases. Hemorrhage from the face of stumps is unquestionably one of the most disagreeable complications which can arise during their treatment. The scorbutic state of the blood of most of our men, made their stumps highly irritable, and liable to sanguinolent oozing. Their strength was thus much wasted, arid other complications of hardly n: >M t.t N-siiu-r WOUFDB. I'll less serious importance were superinduced. All noticed the prevalence of these bleedings when the liot sirocco blew, or previous to those violent thnnder-etorma which did so inurh t<> rh-ar the air. The patients often complained at these times of lei-ling " as if their stumps would burst." and the bleeding seemed to ^ive them much relief.
The blood which flowed was commonly more than arterial, thin, watery, and of a brickdust colour. AYhen cold air, or water, combined with ition, tailed to check it, pressure and the percliloratc of iron generally succeeded. Its appearance was ah an indication tor more fresh air, tonies. and better Guthrie counsels us, in the event of haemorrhage from a thiirh which cannot be commanded by the aption of a ligature to the bleeding point, to tie the main vessel, in the first instance, at a point the aeanri to the end of the at which pressure commands it, provided it be beyond the sphere of the inflammation; and if this fail, then to reamputate the illegible in the scan of the first
The same thing, he says, exist* in the power we have of arresting bleeding in primary and secondary operations those necessitated by accident and rather than cither ligature the femoral high up, or reamputate the limb; this is, of course, always providing that the vessel could not be secured on the face of the stump. Bleeding from a thigh stump is so apt to proceed from one of the deep vessels, and to be temporarily arrested by a tourniquet applied to the femoral, but whose strap encircles the limb, that no ligature of the femoral much above the extremity of the stump could give any security against a return. The fear of gangrene' in depressed subjects when the iliac is tied, is the chief objection to the practice I allude to.