The cases in which attempts were made in the East to arrest haemorrhage from stumps, by applying a ligature to the main vessel above the extremity of the stump, were, I believe, singularly unfortunate. Well-applied pressure along the course of the principal vessel, adapted to diminish the circulation through it, has sufficed, in some few most threatening cases, finally to arrest bleedings which had recurred frequently; but in these cases the implication of the main vessel was clearly made out. Take the following case as an example. The state of the vessel, as discovered after death, also lends an interest to the narrative. Haemorrhage took place to a slight extent, from a thigh stump, on the ninth day after operation, and was repeated on the following morning.
A tourniquet was applied over the course of the femoral, so as to moderate the flow of blood through it. On the fourteenth day the bleeding returned, and the tourniquet was tightened for four hours, so as almost to arrest the current of blood in the great vessel, and afterwards, though loosened, was still left so tight as to restrain the free flow of the blood through the main artery. On the sixteenth GUN-SHOT BOUNDS. ling returned, and tin 1 same tivutment was followed, the position of the compressing force being ally shifted from time to time. From this period the ha morrhage never eared. The patient subsequently died of py<cmia, when it was found tliat an.ad formed around tlie great vessels, extending from the end of the stump for some inches; that was fairly opened by ukvration. to the extent i inch from its termination, but beyond that distance a dense clot occupied its calibre for an inch and a quarter.
The vein contained much pus. Purulent matter was freely df sited in the lungs. Here the ulceration of the end of the artery allowed the bleeding to take, while the subsequent formation of a clot above -'trd it. The exact number of eases in which tchm'is has foll wounds during the war, or the nature of the to it, li; to learn from the army ri turn-. It was not, however, by any means common. I know of six cases only which occurred in camp, and seven which took place at Scutari. The usual proportion to w. according to Alcock, one in seventy-nine, Weh;' r.-nainly not had that In no case, the particulars of which I enuld learn, did it occur after the "lid day the limit as defined by Sir.lames
I cases of which I haye known the deconfirmation of Baron Larrcy's th as to the set id six CAMS in a lint of wounded. fatal. Of the six instances which appeared in front, one followed a compound fracture of the thigh, one a face wound with destruction of the eye, one an amputation at the shoulder, one a flesh wound of the leg, and the other two cases following wounds, without fracture of the thigh, unfortunately happened under my own charge in neighbouring wards in the general hospital, and within a very short time of one another.
Of those which appeared at Scutari, one followed an amputation of the hand, two succeeded compound fractures of the thigh, one was a frost-bite of the toes, one was a compound fracture of the leg, and of the other two cases I could not learn the primary I give the particulars of my own cases, In the records of the army in India, I have been able to find details of nineteen cases of tetanus, of whom only one recovered. The patient had received a severe burn from an explosion of powder, and was treated by the "injection and inhalation of sulphuric ether." In three cases it followed; in three, balls lodged in bone; in four, flesh wounds; one, a penetrating wound of the chest; one, a contusion of the face; one, a wound of the hand; one, a needle broken in the heel; one, the exposure of a suppurating wound to cold air; one, an injury of the foot; in one, a compound fracture; and hi one, an injury of the ankle.
Alcock reports seventeen cases. In ten the disease followed flesh wounds (three of the upper extremity, three of the lower, and one of the trunk). In two it followed wounds of the foot; in four, compound fracture; in one, a primary amputation. All died except two, one of whom was treated by opiates alone, the other by opiates succeeded by large doses of carbonate of iron. Larrey makes reference to many cases in his memoir on the campaigns in Egypt and Germany. He says it was less acute in the latter than in the former country. In Egypt I find reference made to upwards of thirty cases, the details of many of which are not given. All seem to have died within a week of the appearance of the symptoms.