WHEN the flesh is divided with a cutting instrument, the cut edges separate, and the wound has a gaping appearance. This drawing apart happens in consequence of the elasticity of the skin. It often happens that vessels of considerable size are cut, so that bleeding is the principal thing to receive attention.
Treatment of Hemorrhage. Bleeding is stopped by the tourniquet, by the ligature, by compression, by the application of cold water and ice, and by astringents and styptics.
The Tourniquet. This instrument consists of a band and buckle, a pad and two brass frames, the upper of which is furnished with two small rollers, and the lower with four, over all of which the band plays. When the handle is turned to the right or left, the band is tightened or relaxed to just the extent required. (Fig. 155.) The band is buckled round the limb in such a manner that the pad is placed exactly over the artery. When an artery is cut, it is known by the blood being very red, and spurting out in jets; and in this case, the instrument must be placed upon the limb above. the wound, or between it and the heart.
The Ligature. When an artery is divided, the surgeon lays hold
of the end of it with his forceps, and ties a thread tight around it, or
twists the end of the artery. This is called a Zigature. By it, the bleeding is instantly stopped, and long before the thread becomes loose, the opposite sides of the vessel have grown together, and all danger of a renewal of the bleeding is over. In all these procedures the careful surgeon uses only disinfected instruments and ligatures.
Application of Water and ice. This is done by saturating with cold water several folds of linen rags, or lint pads, and applying them' to the wound, remoistening, and reapplying them as fast as they become hot, till the pain and inflammation subside.
Compression. When the blood does not come from any large vessel, but from several small ones, compression is sufficient. It consists in placing the opposite sides of the wound together, if possible, and then laying compresses over, and applying a bandage with moderate tightness.
Astringents and styptics. These are spirits, tinctures of myrrh, Peruvian bark, diluted mineral acids, solutions of tannin, alum, sulphate of copper, decoctions of white oak bark, etc. These have the power to stop bleeding from small vessels. Monsel's salt is said to have more power than all the above. It is a preparation of iron and nitric acid, and has been used with great success in stopping violent bleeding. It is not a caustic or an irritant; but it acts very powerfully upon albumen and blood, producing with the latter a large clot, absolutely insoluble, which continues to enlarge for several hours after the application, and becomes quite hard and firm, so that no blood can get through; but it leaves the wound filled with clots which afterward decompose and often give rise to blood poisoning. The compress wrung out of some antiseptic solution is always the best method when practical.
Beside these means, the application of the lunar caustic, potash, and the hot iron, are used, particularly the first, quite often.
Union by the First Intention.
WHEN the bleeding is stopped, all foreign substances removed, and the wound properly cleansed, the next thing is to bring the opposite sides of the cut evenly together, and to keep them steadily in this position till they have healed. If this method succeeds, the healing takes place without the formation of any pus. This is called healing by the first intention, or adhesion. The cut surfaces grow together. For keeping the surfaces together, straps of adhesive plaster are used, putting them at right angles across the cut, and leaving spaces between them. sutures. Incised wounds are sometimes sewed together by what is called the interrupted suture. After the bleeding is stopped, a curved needle is threaded, and, the lips of the wound being brought together, is introduced through the right lip, and then, being directed across the wound, is pushed through the left lip, from within out, ward. It is now cut off, and tied in a bow. These stitches should be at least an inch from each other. These needles and sutures are, of course, to be boiled or otherwise rendered aseptic before using, as well as the hands of the one doing the sewing. Needles and thread come all ready put up in glass tubes, having been first sterilized, and kept in alcohol or in a vacuum for any length of time perfectly germ. free.
The first plasters and dressings should remain on the parts at least three or four days, unless very great pain, bleeding, or some other bad symptom, should call for their removal.
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