Year: 1862

injured the sufferer will probably bleed 10 deAth'
unless aid be afforded, by making compression
above, and on the bleeding part. A long, ouL


not broad stone, tied sharply on with hanKer-


chief, will often suffice until assistance can Dc
obtained, when both ends OF the divided OF
| wounded artery are to be secured Dy lg&'uIes.
%. 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 a case of accidental injury unless there
have been previous disease IN the limb A
knowle3ge of this fact or circumstance, which


continues for several days, viii prevent mis-
take at the moment of injury, and at subse-


quent period, il secondary hemOrrhage should
/ occur In the upper extremity both ends OF the


nrincinaI 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.


/ Il frequently follows a wound Of the principal
artery in the under, middle, or even lower parts


OF the thigh rendering amputahon necessary.
q. II is a great question, when the bone is
uninjured, where and what part the amputatiOn
/ should be performed. Notification of the foot
and leg, from such a wound, is disposed to stop
little below the knee, if it should not destroy
the sufferer and the operation, if done in the
first instance as soon as the tallOwy or mottled
appearance OF the foot is observed, should be
done at that part the wound of the artery, and
the operation for securing the vessel above aud
below the wound, being left unheeded. By this
proceeding, when successful, the knee,joint is
saved, while an amputation above the middle of
the thigh is always doubtful in its result.
2S When modification has taken place from
any cause, and has been arrested below the
knee, and the dead parts show some sign of sep
arati0n, it is usual to amputate above the knee.
BY not doing it, but by gradually separating and
removing the dead parts under the use of disin-
fecting medicaments and fresh air, good stump
may be ultimately made, the knee-joint and life
being preserved, which latter is frequently lost
after emputatiDg under such circumstances


y. 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 acid, 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
leet, and should be used as seldom as possible


81. ChlorOform may be administered in all
cases Of amputation 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.


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


2i. If the young surgeon should not feel
quite equal to the ready performance Of the va
riOus operations recommended, many of them
requiring great anatomical knowledge and man
ual dexterity (and 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
labors OF their predecessors during the war in |
the Peninsula. 1t is expected, then, that they |
viii not only correct any errors into which their
predecessors may have fallen, but excel them by |
the additions theiroPpertunities will permit them
to make in the improvement Of the great art and |
science Of surgery.-LORdOR Lancet for June.