OCR Text |
Show 254 m.~,¢-~1-A.na-‘~ wzr- "u continues to make its way into the part, even of the trunk of the artery which is below the ligature. This interruption to the blood, forcing it to take a circuitous route, gives opportunity for the entire coagulation of the blood in the sac, and then the cure takes place much in the manner of the spontaneous cure of aneurism. The preceding case, however, proves that where there is no regular sac and where the artery is wounded, this tying of the trunk of the artery high in the thigh, is not sufficient to stop the flow of blood from the wound of the artery. I made another dissection which proved to me, that after the usual operation for the common case of popliteal aneurism the main artery continues pervious below the ligature ; and that it is the femoral artery and its branches, (and not the me tremities of the profunda, articulating with the recurrent branches from the artery below the aneurism,) which carries on the circulation. Six weeks after the operation for aneu~ rism, it was necessary, in consequence of partial mortification, and a caries of the fibula and bones of the foot, to amputate the limb. During the amputation I observed the blood flow in full jet from the femoral artery, on the face of the stump. Now the artery was here cut across not more than two inches below the place of the ligature used in the operation for aneurism. 0n injecting the anterior tibial artery with wax, the injection passed freely into the branches of the popliteal and femoral artery. So it is certain that here the blood was car- -_ " ried into the leg by the trunk of the femoral and popliteal artery, and that the main vessel remained pervious betwixt the ligature applied in the operation for aneurism, and the sac of the aneurlsm. It follows then, that where there is a regular sac of an aneurism, the operation usually performed will be successful, by diminishing the force of the circulation, and allowing the blood in the sac to coagulate. But that where there is an open wound in the artery, and an extensive irregular cavity into which the blood flows, this ligature applied so high in the limb is insufficient, and the patient will most likely sufl‘er amputation at last. . , W-‘flj‘ -'vvan-'f-r~,.,4 a or wousnnn snrenlss. OF WOUNDED ARTERIES- XII. I CANNOT close this chapter without saying something of the secondary bleeding from gun-shot wounds, in consequence of the slough coming away. In the first place I positively deny that because a gun-shot wound bleeds, there must therefore be a great artery wounded ; for I have seen wounds of the thigh, of the axilla, and arm, by musket balls, where much blood flowed, and yet there was no secondary hmmorrhage, and no great artery wounded, as the event of the cases shewed. It Would be great presumption in me to contradict the opinion of Mr. Hunter upon a subject of this nature, yet as I have felt alarms in consequence of what he says and others . think they have confirmed, and have found my fears groundless, I think it necessary to state, that while I would still take the precaution recommended by so many in regard to the secondary haemorrhagy from gun-shot wounds, yet I do not think there is that occasion for trembling anxiety, which I at first conceived there was. On a late occasion, when I went among the wounded from Corunna, I had two purposes in View, first to satisfy myself on several points, of which I had just knowledge sulficient to make me doubt the received opinion; the other was that I might have striking instances of acknowledged facts, for the purpose of teaching; and amongst other accidents I thought we should have secondary llremorrhagy. I hope it will not be irrelevant that I state from my notes the opinion as it grew. . ,_ " It is singular that of all the hundred wounds of balls in these wards, with the sloughs hanging from the wounds, there is no instance of haemorrhag ." In succeeding mornings I find still the same expression in my notes. " Now the slough is just coming out of several of these wounds; in cases too where I should imagine the artery must have been touched, yet in bringing the men ashore there has been no bleeding. I see a. man wounded in the sartorius very near the femoral - ""V , 1 ,«r-rxT-TT‘T; f- wbm moss» |