When from a punctured wound profuse hemorrhage ensues, there is reason
to suspect that an important vessel has been hurt, and the bleeding
point must be sought for. After the artery giving out the blood has
been discovered, the external wound must be enlarged, so as to expose
the vessel, and admit of the convenient application of a ligature. It
will not be sufficient to include the vessel above the wounded point,
for the lower part will, after some time, be supplied with blood
by the collateral branches almost as freely as by the large trunk,
and, consequently, bleeding will be renewed. Two ligatures are to be
employed, one above, the other below, the wound. The wounded vessel
must be exposed, as already stated, but not detached more than is
sufficient for the application of the ligature; and at the same time
the ligatures ought to enclose nothing but the vessel. Neither ought
the ligatures to be placed at any considerable distance, but as close
to the wounded point as possible; otherwise circulation in the included
part may be restored. The ligature, round, narrow, and firm, ought to
be tightly applied. Cases of hemorrhage have occurred in which the
tying of the vessel immediately above the wound has been successful;
but these are few, and by no means afford any authority for the general
adoption of such a measure. If the vessel is merely punctured, it is
necessary to apply the ligature by means of a blunt pointed needle, and
the parts are to be disturbed as little as possible. If, however, the
artery is completely divided, its cut extremities are to be drawn out
of their sheath by a hook or forceps, and the ligatures applied close
to the connections of the vessel; the vasa vasorum, in the immediate
vicinity of the deligated point, being left to carry on those processes
by which obliteration is accomplished. In punctured or partial wounds
of arteries, it deserves consideration whether the hemorrhage may not
be restrained by the application of slight pressure, so regulated as
to prevent the flow of blood laterally through the wound, but not so
forcibly applied as to stop the onward current of the blood along the
vessel, from the part of the tube above to that below the puncture.
Some experiments made by Dr. Davy seem favourable to this view; as
bleeding from the carotid arteries, partially divided transversely, in
dogs was easily arrested by the means above-mentioned, the wound of the
vessel readily healing, so as to preserve its tube entire; whereas,
when the pressure was increased, the hemorrhage became violent.
The subject is mentioned as one worthy of a further experimental
investigation. The instrument which will generally be found most useful
for laying hold of the vessel is the common dissecting forceps, but a
tenaculum will, in certain circumstances, be more convenient. By far
the most convenient machine is that here represented.
[Illustration]
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