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Show or wonnnnn nnrnmas. or WOUNDED nnrnmrs. I know not on what grounds the surgeon determined in the preceding instance, but he took up the humeral artery, and not the radial artery. Still the bleeding continued. This put my notions of the effect of ligature into strange perplex-; ity. Still the patient bled, and what could be further done ? In this slight sketch I have represented the place of the wound of J. Chambers, of the rifle corps. He was wound ed 9/15 --and in a short time he died. On dissection, I found the radial nerve with a firm ligature around it, but the humeral artery was not included. I never had seen the radial nerve mistaken for the humeral artery, but this was the third time I had found the radial nerve with a ligature around it. This is a pure case of a division of the radial artery, by the knife, proving fatal; and these cases leave no room for conjecture on the difference between gun-shot wounds, those by splinters, and the clean cut of a knife. It is in this latter case especially that we have to cut down upon the artery and take it. up. I HAVE stated that the branches of the profunda femoris require the ligature; but from the diiliculty of the dissection, the uncertainty in regard to the branch which bleeds, and the precise place of it, we shall be long held in susPense, and perhaps obliged to trust to compression. In gun-shot wounds the case is still more perplexing. 244' in the retreat at Villa Franca; the ball entered under the edge of the sartorius muscle, passed obliquely through the flesh of the thigh, and round the bone, and lay under the skin near the trochanter major. The wound bled freely on his first receiving the shot. He was thrown on a mule, and for three leagues on the retreat he continued to bleed. The surgeon cut out the ball, and bound up the limb, and then the bleeding stopt ; but it broke out again, and continued to bleed for ten days; and after this, when aboard the trans- port, there was great bleeding, so that they were obliged to apply the tourniquet, &c. The wound continued to bleed till within two days of his coming ashore. A wound of the femoral artery would have prevented him from ever rising trom. where he fell. This has been a wound of the branch of the profunda, which descends before the insertion of the long head of the triceps, and which is behind the great artery, yet although a branch, it is as large as the brachial artery, and its importance is shown by its continuing to bleed for thirteen days-from its requiring the tourniquet eleven days after the wound was received. This artery, however, was at last stopped by the compress and roller-but had it been cut with a knife the bleeding would most probably have been fatal, if the artery had been left armoured. ‘ - .. "at VI. .: ' ./ 37/22,. ,.. /.//// ////?l ' I r-WJ'W.‘ -‘vvw-'4~«.- .__.,_. "".[ J: IT will not be denied, (though I know not where the im: portant fact will be found distinctly stated), that it is not the size of the artery which makes it to be dreaded, but its comparative size; and this not in comparison with the size and years of the patient only, but its principal importance. hangs on the question whether-is it the main artery of a limb, or abranch ? From a branch of the profunda, equal to the brachial artery in size, the man is less likely to bleed to death. than it the wound is in the brachtal artery. mm M059» |
