those which have been already detailed in regard to arteries.
In many, nay in most, instances of hemorrhage from a wounded artery,
the surgeon cannot wait for the natural processes by which the flow
of blood is arrested, but must have recourse to immediate and certain
means. In division of the smaller arteries, or in minute wounds of the
larger, pressure, well applied, will often be sufficient. In both cases
it immediately stops the flow: in the former, it prevents the blood
from penetrating into that portion of the sheath which has been vacated
by the retracted artery; and it being thereby confined, and kept in
a state of rest, coagulation soon takes place. At the same time,
the compression brings the divided margins of the vessel into close
apposition, and thereby permanent closure, by adhesion, is quickly
accomplished. In the latter, the mere circumstance of the escape of
blood being prevented, naturally hastens the closure of the minute
aperture by the natural process; and, if the compression be accurate
and very firm, the opposite surfaces of the vessel, being brought in
contact, may adhere, and the canal be obliterated at the wounded point.
It is obvious that, in this latter class, pressure can only be of
advantage immediately after the infliction of the wound, and not when
blood is extravasated to a great extent.
Pressure may be used along with styptics, or along with escharotics,
actual or potential. They may be often employed when pressure ought
not; styptics promote the contraction and retraction of the divided
extremities, and thereby expedite the formation of a coagulum.
Escharotics form a slough, which, adhering to the extremity of the
vessel, stops the flow of blood, and the cut margins of the vessel,
being stimulated by the application, soon cohere. Active stimulating
applications merely cause effusion quickly of coagulated lymph, and
thus often arrest hemorrhage from very vascular surfaces better than
the so-called styptics. Not unfrequently, after the separation of the
slough, it is found that union has not taken place, and hemorrhage
is renewed; from this circumstance, the remedy cannot be trusted to,
except when the divided vessels or vessel are of small size. It may
be stated, generally, that these means are of little avail without
methodical pressure. In oozing from small vessels, pressure may be
applied by means of agaric, sponge, or lint. In bleeding from small
vessels, where there is general oozing from the surface, and pressure
cannot readily be made, applications tending to produce effusion of
lymph—stimulants, such as turpentine or creosote, are often remarkably
efficacious, and very speedily so; but in wounds of the larger vessels,
the most efficient mean is a graduated compress of lint placed
immediately on the external wound, and supported by a firmly-applied
bandage. The bandage ought to encircle not only the wounded part, but
every part of the limb with a uniform tightness, not so great as to
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