OCR Text |
Show 0..."... fi.,.._‘ mum... a»: ..-=.-.-,.,.. . .. 252 ,_ "urn-7s -VVIW%t'~ o‘- .r a...‘ ‘3 trait, or wovnnnn surnames. or wounmm ARTERIES- and continuing the incision from the lower wound, down im to the hand, four ounces of well-digested thick pus escaped ; I made another incision on the back of the arm and found the blood equally diffused, the muscles and cellular substance appearing one black mass, with every sigrf of approaching gangrene. The next morning I found him sitting up in his bed, quite cheerful; pulse soft, full, and considerably reduced; fearful lest adhesion might not take place by the first intention, and having no after inflammation to dread from the great loss of blood previous to the operation, I ordered him a dram of bark four times daily. The second day I found him walking the room without the smallest degree of To say, that in any case where the radial and ulnar arte ry is cut by a ball the arm should be amputated, would be wrong. The arteries may both be taken up if the surgeon be on the spot; but when there is a raking musket-shot through the fore'arm, and the arm is swelled, and the cellular membrane stuffed with extravasated blood, and the patient reduced, the case is totally altered. fever : cautioned him to be careful, but did not confine him to bed. The fourth day I opened the stump, found that very little adhesion had taken place; a great discharge of coagulated matter from the stump; dressed the stump, and continued his bark as before. 011 the next dressing I found the matter better, and less in quantity than on the former dressing; the wound discharging a thick pus, and skinning over very fast. Continued his bark and dressings until the twenty-eighth, when the stump almost skinned over; but the French getting possession of the Fair Water, he fell into their hands to complete the cure, which only wanted a few superficial dressings. There is always much difficulty in stating an aphorism in surgery; in other words, the circumstances of the case are infinitely varied, and much is left to the discretion of the surgeon. A wound of the radial, or ulnar artery, is no case for amputation, nor would I amputate although one of the bones, and one of the arteries were pierced by the ball. But where both arteries are torn by a raking shot, in the manner above described, there can be no doubt of the propriety of amputation; because to compress these arteries is to compress the whole arm, and to allow no circulation; to take them up requires extensive incisions, and taken in addi-_ tion to the wound, would leave the arm too much mangled to do good. 253 XI. "7111er on this subject of wounded arteries, I am tempted to state some further facts regarding the force of the circulation by collateral anastomosing arteries. A man having suffered a fracture of the lower head of the femur, had the misfortune, at a considerable distance of time, to have the popliteal artery torn on the rough projection of the bone. A tumour formed behind the knee ; the progress of the tumour was more rapid than the common popliteal. aneurism. The operation for aneurism was performed on the fore part of the thiglL By the tying of the femoral artery the swelling was only checked for a time; by and bye it began to increase ; the knee joint became greatly distend- ed; ulceration took place near the head of the fibula; and from this, pure blood escaped, so as to endanger the patient's life, and render amputation absolutely necessary. In the amputation the femoral artery gave out its blood, and was secured as usual. 0n Dissection, I found that the blood had continued to pass from the popliteal artery into the sac of the aneurism, and that the main artery was plentifully fed by the anastomosing vessels. The blood which escaped from the ulcer had come directly from the popliteal artery, in which there was a ragged hole. This proves, that in the case of common popliteal aneurism, where there is a proper sac, the ligature on the femoral artery checks, but does not altogether impede the course of the blood into the sac; it interrupts the main channel through the trunk of the femoral artery, while the blood ‘5‘: 1" " any war), W999" |