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Show or WOUNDED sutures. 01' TYING 01" ARTERIES. VII. Ir a man is wounded in the main artery of the thigh, or arm, from the weapon entering in at the outside of the limb, it must be evident that the original wound cannot be enlarged to seek the artery, as has been proposed. To take the most favourable case for this proposal, I say, that if a man be wounded through the flesh of the triceps, and the sword pass into the humeral artery, we cannot dilate the wound to expose the puncture of the vessel. We must pass the gun-shot probe into the wound, and pass it forward un» til we can feel its point on the skin on the inside of the arm, and near the artery. Here we cut upon the artery, and make sure that this incision communicates with the original wound; and if we do this, there can be no embarrassment . tum sham Wt ,. . ‘l‘l" .T... from the artery continuing to bleed by the wound towards the outside, while we are dissecting for the artery on the inside of the arm. If in searching for the wound of an artery the blood doesnot flow, although you are sure that the side of vessels is wounded, compress the artery below the supposed place of the wound, and the blood will start out. [.m'v u‘ruWa-WVM.4 .r-" ‘d' VIII. 248 difficulties: viz. whether in certain cases a ligature being put around the artery above the wound, the patient is quite se- cure ? or if it be not necessary to tie the lower part of the artery also .9 On this subject I shall state what appears to me to be the fact, and endeavour to draw the safe rule of practice. While these papers are before me my assistant is called to take up the radial artery, where it has turned from the fore part of the wrist. He finds a man with a deep wound of a knife betwixt the fore-finger and thumb: the man has already lost much blood; and introducing the probe it is found, that the point of the probe is at the head of the metacarpal bone of the thumb. The artery is taken up by the side of the extensor tendons of the thumb. The bleeding is stopped, yet in a short time the blood flows again; but the wound being tied up, with a compress laid in the course of the wound, all is well. When a man is bleeding from the hand, or wrist, or foot, tying the artery only diminishes the impulse of the blood, and does not entirely stop the flow of blood which comes round by the very free inosculations.-But the direct course of the blood being interrupted, our dressing is sufficient to stem the force of the haemorrhagy by the anastomosing vessel ; if the artery be not taken up, a sponge must be thrust deep into the wound, and a tedious sore is the consequence; but if the main supply be stopped, the lips of the wound can be brought together, and the eonr press put over the integuments, (not into the flesh), and the Wmay we cut down upon the artery of a limb, and having found it, are about to separate the vein and nerve from the artery, we must bend and relax the limb, by inattention to this rule I have seen the radial nerve twice included in the ligature put around the brachial artery. wound healed by the first intention. If the surgeon be brought to a man who has received a wound in the inside of the arm, and he has reason to sup- IX. is wounded, ought he to be satisfied with pulling out some» thing from the bloody wound, and tying it? nay, even sup-e posing that he distinctly sees the extremity of the artery, and the blood flowing from it, is it sufficient to tie that mouth I '1' does not appear to me that surgeons have determined. whether a single, or a d0uble ligature be required in case of a wounded artery. I am sure that some may entertain these pose, from the dashing of the blood, that the humeral artery of the artery ? I believe, that with common care afterward, and due compression, the patient will not (lie of hmmorrhaVOL. 11.. I 9 m I?" ,' 5:;‘rjrwlir ‘ ' . , v , mm Mossy |