Year: 1862

injured, the sufferer will probably bleed to death,


unless aid be Afforded by making compression


above, and on the bleeding part. long, put


not broad stone, tied sharply on with hanAer-
/ chief win often suffice until assistance can De


obtained, when both ends of the divided or


wounded artery are to be secured byligatures.


25. The upper end of the great artery OF the


thigh bleeds scarlet blood, the lower end dark
venous-colored blood and this Is not departed
from in q case of accidental injury unless there
! have beeu previous disease IN the limb.
! knowledge of this fact or circumstance, which
continues for several days, viii prevent ms
! take at the moment Of injury, and at subse-
quent period, if secondary haemorrhage should
occur La the upper extremity both ends Of the
principal artery bleed scarlet blood, from the
| free collateral circulation, and from the anasto-
moses in the hand.


26 From this cause, modification rarely takes
place after wound Of the principal artery OF the
/ arm. or even of the arm-pit


1t frequoatlg follows a wound of the principal
artery in the under, middle, or even lower parts
of the thigh, rendering amputatiOn necessary.


q. 1t is great question, when the bone Is
uniniured, where and what part the amputation
should be performed Notification of the foot
and leg, from such a wound, is disposed to stop
a little below the knee if it should not destroy
the sufferer and the operation if done in the
first ms lance, as soon as the tallowy or mottled
appearance Of the foot is observed, should be
done Bt thGt part the wound OF the artery, and
the operation for securing the vessel above and
below the wound, being left unheeded By this
proceeding, when successful, the knee-ioint is
saved, while an amputaton above the middle Of
the thigh is always doubtful in its result.


%. When modification has taken place from
any cause, and has been arrested below the
knee, and the dead parts show some sign of sep
araion, Is is usual to amputate above the knee.
BY not doing it, but by gradually separating and
removing the dead parts, under the use of disiu-
fecting medicaments and fresh air, good stump
may be ultimately made, the knee-joint and life
being preserved, which latter is frequently lost
after amputatiDg under such circumstances.


%. Hospital gangrene, when it unfortunately
occurs, should be considered to be contagious
and infectious, and is to be treated locally by
destructive remedies such as nitric seid and the
bivouacing or encamping of the remainder of the
wound, if it can be effected, or their removal TO
the open air.


80. Poultices have been very often applied in
gun-shot wounds, from laziness, or to cover neg
lect, and should be used as seldom as possible


81. Chlorolorm may be administered in all
cases Of amputstion of the upper extremity and
below the knee, and in all minor operations
which cases may also be deferred, without dis
advantage, until the more serious operations are
performed.


81 Amputation of the upper and middle
parts Of the thigh are to be done as soon as pos
sple after the receipt Of the injury. The ad-
nlinistTation of chloroform in them, when there
is much prostration, is doubtful, and must be
attended to, and observed with great care. The
question whether it should not be administered
in such cases being undecided.


q. If the young surgeon should not feel
quite equal to the ready performance of the va
nous operations recommended many of them
requiring great anatomical knowledge and man
ual dexterity land it is not to be expected that
he should), he should avail himself of every op-
portunity which may offer of perfecting his
knowledge.


The surgery Of the British army should be at
the hight Of the surgery of the metropolis, and
the medical officers of that service should recOl
lect, that the elevation at which it has arrived
has been on many points principally due to the
lsbors OF their predecessors, during the war in
the Peninsula. 1t is expected, then, that they
win not only correct any errors into which their
predecessors may have fallen, but excel them by
the additions opportunities win permit them
to make ia the improvement Of the great art and
science Of surgery.-LOadOa Lance or Jlrne.