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Show or WOUNDED Anramns. gy; but I am at the same time Convinced, that when the principal artery of a limb is thus severed, or wounded, a ligature ought to be applied both above and below the wound ; and then only can the limb be left free of bandages and compresses, which in this case is especially necessary. These bandages not only prevent the early union of the cut, which is a minor consideration, but they do not allow the free 'circulation through the limb by the collateral arteries, now that the main trunk is cut and tied. \Vhen the main artery of a limb is tied we expect the free course of the blood by the anastomosing branches still to supply the lower part of the limb; and surely, when we are so confident of this expectation, we cannot doubt the propriety of tying the artery both above and below the wound, so that there may be no fear of haemorrhagy from the returning blood, and no necessity for a compress to be put into the wound. A .,. HM X. A QUESTION may still remain with my reader in the case of a wound of the fore arm, or leg, when the ball has torn both arteries what is to be done 2' I take particular pleasure in producing the following case, presented me by Mr. Torbit, of the Crescent, formerly a pupil of mine. A case or DIFFUSLD ANEURISM wmcn HAPPENED AT THE 3113013 or DANTZIC, MAY THE THIRD, 1807. Ii"... ‘3. -‘-r; 1."W_ #9... . "a. s, , t we 250 A PoLlsn pilot was offered a pecuniary reward, from the British Consul, to carry dispatches from General Kalkruth, commanding the garrison of Dantzic, to General Kaminski, commanding the allied Russio-Prussian army in the Fair Water. On his passage in an open boat down the Vistula,‘ he was fired at by the French sentinels from both banks of the river, and received a wound from a musket ball, which or wounpan ARTERIES. 251 the ulna, carrying away both radial and ulnar arteries. A profuse haemorrhage followed, but he continued to exert his strength to get clear of the sentinels, until he fainted from the. loss of blood ; the boat was drifted down by the current into the Fair Water by the time he recovered. He made another effort and regained the shore, but weak and worn out by the loss of blood he fell down, and was taken up by a Russian out-post, and conveyed to an inn. A compress and roller was applied, and his strength supported by wine and a nourishing diet ; the arm became much swelled and painful ; fresh bleedings from the wound followed every two or three days, and then fresh bandages or compresses were added to the former, until the seventeenth. I was called in to visit him. I found him pale, with a livid countenance, and his eyes sunk in his head; his pulse in the right arm was one hundred, and upwards, and scarcely perceptible; the hand was much swelled, and soft to the touch, as if pus were formed. I recommended amputation ; dreading from the length of time, and the state of the cellular membrane and muscles, that mortification was approaching. A consultation of English and Prussian surgeons was held at six o‘clock the same evening. I entered the room a few minutes too late, when a Prussian surgeon was undoing the last turn of the roller; the blood sprung from the wound across the room -, the surgeon stood amazed-without making any endeavour to stop it. I laid hold of the arm, and compressed the artery on its passing out of the axilla, and applied the tourniquet. On exposm ing the arm, the whole appeared marked with the roller, whose spiral pressure left evident marks of its inclosing a fluid diffused among the muscles, and the arteries still continuing to bleed internally, I amputated the arm above the joint, which the patient endured with great resolution. I gave him an opiate, and ordered him a glass of port negus three times in the course of the night. Dissncrron. I made an incision in the course of the entered the left arm from without, about two inches below wound and found both arteries wounded, and the whole of the elbow joint, the ball made its exit at the lower end of the interstices of the muscles filled with coagulated blood; ...~.» ll 31‘YF""‘ii-.w 1 ram ._MP€?V. |