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Show ‘3': nvc- - _., .31": -;. . 240 '\ l 1 i CLASS 111. Arteries, the bleeding from which is profuse and dangerous, and which require the ligature. These are the arteries of the leg-the ulnar and radial arteries-the gluteal and ischiatic arteries-the sub-scapularis -the thyroid and lingual arteries, and the branches of the profunda femoris. CLASS IV. Arteries which require careful compression, and if that be not possible the ligature-the internal pudic---the epigastric-the arteries in the sole of the foot and palm of the hand-the interosseous artery of the fore arm-the intercostal arteries~thc temporal and fascial artery, and occipital arteries. Cnxss v. This is a class of arteries that can be trouble- some only in cases of great weakness, or when they are in bones or fungous surfaces. ‘J lllllilfil, rill? r . "V" "‘2‘ -Vfi-'am‘-=;- r ..a. ._ or WOUNDED ARTERIES. or WOUNDLD ARTERIES. Ir there be bleeding from the hand or foot, and the surv goon is called soon after the accident has happened, and before any clumsy attempts have been made to stem the bleeding, he may put down a piece of sponge into the wound, and then a graduated compress being applied, the vessel will be effectually closed. But if the blood has been driven from the mouth of the artery into the cellular membrane, and under the aponeurosis, the compress cannot be used with accuracy and cli‘cct ; neither can the tcnaculum be used, because the mouth of the artery is hid; and the needle cannot be used, because the mouth of the bleeding artery is amongst nerves and tendons. So it happens that a wound of a trifling artery in the hand or foot requires the ligature of an artery of greater size in the wrist or at the ancle. My reader now enquires whether all wounds of the artet» ries of the foot and hand require a ligature .9 Certainly not. I have seen the hand pierced and shattered in all directions by balls, and no ligature required. I have seen in the same 2&1 day three gun-shot wounds through the palm of the hand, without hemorrhage, or more than was to be wished for. In the use of a compress, this is not enough consideredthat inflammation as well as pressure is required to the obliteration of an artery. If there be a considerable thickness of cellular membrane, or a fascia, betwixt the lint or sponge and the artery, the pressure may very likely fail, whereas if the compress had been put down in contact with the artery it would surely have succeeded ; for then the pressure not only keeps the sides of the vessel together, but the contact of the. foreign body causes inflammation and adhesion. It will accordingly happen that. the ulnar artery being wounded where it forms the arch in the palm of the hand, we shall in vain try to compress it hbecausc the cellular membrane is charged with cxtravasated blood, and the artery has shrunk under the aponeurosis: the compress does not touch the artery and there is a great thickness of a substance like placenta over it. On another occasion findingr an open wound, and the artery displayed, and no such driving of the blood as in into the palm of the hand, and no such general swelling the last instance, the compress being put down into the wound and the hand bound over a ball of cotton 01' lint, the int;morrhagc will be effectually suppressed. III requires IT is more difficult to say what size of an artery likely very is It ned. a ligature than may be at first imagi upon down g that while I am describing the manner of cuttin , or ulnar the arteries of the third class, the tibial or fibular , for arteries, a naval surgeon may say, " all this is superfluous shew to have I I have stopt these arteries by compression." necessary that I know this, and yet that I deem it sometimes to take up these vessels with the needle. He stood John Roe was shot in the arm and in the breast. ng out the with the tackle in his hand ready to help in runni the men at the gun, when a shower of grape-shot shattered voL. 11-. 11 9 ' i'"'j‘f;~r‘v‘ ll" VlUNl M0597 |