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Show 52 annnnisn or THE ARM. ANEURISM or THE ARM. immediately after the operation, I have felt the pulsation hey hind the elbow, and feebly in the wrist. THE instruments necessary are only the common pocket case, scalpel, directory, probe-pointed history, a blunt hook, and aneurismal needle, and the tourniquet. I. coloured cavity ; and, from the bottom of this, on unscrewing the tourniquet, you see ajet of blood. The tourniquet is applied by the assistant, who takes the management of it. The arm is held down upon a pillow. You make the incision, beginning by the side of the biceps muscle, over the most prominent part of the tumour, longitudinally in respect to the arm, and so as to reach at both ends a full . inch beyond the base of the tumour. an" ""Lr: .90.)qu mull-l.- , \H ‘3 "a." *1 p, H. .. 5,55 43".."1ygdxau We have here to recollect, however, that in some cases the artery has been entirely transfixed by an adventurous bleeder ; and that, in consequence of this, the blood has been accumuv lated behind the artery, and the artery presented immediately . under the fascia. When the fascia is slit open, you can recognize nothing with which you are previously acquainted. Instead of the artery and accompanying vein and nerve, there is an irregular dark- OPERATION. , "A 53 The integuments retracting, there rises into view a firm dark-blue tumour, formed of the impacted blood, covered by the shining fibres of the fascia. The fascia, far from being stretched so as to lose its charac~ ter, has become stronger, and more tendinous. This brings us to consider the anatomy of such a tumour. We have to recollect the dill'erence betwixt the opening of a bloody tumour, and a deliberate and orderly dissection. of the finger is lifted. When the fascia is cut, the crooked arm will be allowed to fall flat on the cushion; but at this part of the operation we must bend it again a little, to allow us to separate easily the artery and the nerve. We must not dive with the needle above and below the bleeding orifice, else we shall include the radial nerve, as I have seen done; but separating slightly the artery from its bed, not cutting it up extensively, lest we touch some enlarged collateral branch : two ligatures are The simple, though accurate ideas we have received in dissection, are apt to be confounded in operation. \Ve think we are acquainted with the situation of the arteries, veins, and nerves; but we find nothing which we have ever seen before. III. Puncturing the fascia, we slit it up in all the length 01' the tumour, either introducing the finger or the directory before the bittory. With the finger, warm water, and sponge, the coagula are to be cleared away. We are now directed in general to turn the tourniquet, and allow the vessel to bleed ; but much may be done previous to this. ‘We put down the finger upon the spot where we see or conceive that the puncture of the artery has been made. And now the tourniquet being turned, we see that this is the point, by being enabled to command the. bleeding, and by the jet which is thrown out, when the point to be laid under it, the one above, and the other below the orifice: tying the upper one, we have the comfort of seeing the blood return from below, then we tie the lower ligature. Bringing the integuments together, we dress the wound lightly, and keep the tourniquet upon the arm, as in amputation. The arm is laid upon a pillow, a piece of flannel over it, and a bottle of warm water under the palm of the hand. The arm and hand are at first benumbed and cold, but soon re- gain their natural heat. From the sixth to the tenth day. W , 7 b a "I mm .Mlfllll ' |
