General surgical pathology and therapeutics : in fifty-one lectures / by Theodor Billroth ; translated from the fourth German edition, with the special permission of the author, and revised from the eighth edition, by Charles E. Hackley.

  • Billroth, Theodor, 1829-1894.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: General surgical pathology and therapeutics : in fifty-one lectures / by Theodor Billroth ; translated from the fourth German edition, with the special permission of the author, and revised from the eighth edition, by Charles E. Hackley. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    possible, and twist till it breaks off. In this way I have twisted ves- sels from the smallest size to that of the brachial, so as to securely arrest the bleeding. If branches leave the artery just above the bleeding-point, it will not be movable enough to make the torsion securely; hence I have never tried torsion for the femoral; but other surgeons have done so successfully. 2. Compression.—Pressure on the bleeding vessel with the finger is such a' simple, apparent method of arresting hmmorrhage, if we may call it a method, that it is strange the laity do not resort to it at once; any person thaf has seen one or two operations would instinc- tively hold his finger (m the bleeding vessel; still how rarely people do this in a case of accidental wound! They prefer resorting to all sorts of home remedies; spider-webs, hair, urine, and all sorts of filth, are smeared over the wound, or else they run for some old woman Avho can arrest the bleeding by magic. And no one around thinks of compressing the wound. Methodical compression may be made for one of two purposes, as provisional or permanent. Provisional compression, which is used till we can determine how the bleeding may be best arrested permanently, may either be made by pressing the bleeding vessel in the wound against a bone, if possible, or by pressing the central part of the arterj-^ against the bone at some distance from the wound; the former, as we have al- ready stated, is to be done when we propose to ligate the trunk; the latter, when we wish to tie the bleeding end of the artery, or to ex- amine the wound more carefully. Wliere shall we compress the arter}’’, and how shall we do it most efi'ectually? To compress the right carotid., you would place your- self behind the patient, and lay the tips of the second, thhd, and fourth fingers of the right hand along the anterior border of the sterno-cleido-mUstoideus muscle, about the middle of the neck, and press firmly against the spine, while you pass the thumb around the neck, and with the left hand bend the patient’s head gentl}'- to the wounded side and somewhat backward. You should distinctly feel the pulsation of the carotid artery. Firm pressure here is quite pain- ful for the patient, for the vagus nerve is unavoidably compressed, and the tension of the parts necessarily acts on the larynx and trachea. From the free anastomoses of the two carotids, the effect of compres- sion of one of them, in arresting bleeding from an artery of the head or face, is not generally very great, and perfect compression of both vessels requires so much space, that we must generally be satisfied with diminishing the volume of the arteries by incomplete compres- sion. Compression of both carotids is always a very painful and ter-