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.

    60/806 (page 34)
    If you have a hcemorrhage from the arm or leg, that you wish to arrest by compression—if, for instance, large quantities of blood are being poured out from a dilated diseased vein, or if there be bleeding from numerous small arteries—you may apply a bandage firmly from the lower to the upper part of the extremity, having previously covered the wound with a compress and charpie, and after applying several thicknesses of linen along the course of the chief artery of the extremity. For the latter purpose you may also employ the graduated compress, which you Avill learn to make in the course on bandages. To this, which is called Theden's dressing, it is well to add a splint, to keep the extremity perfectly quiet, for the bleeding is readily renewed by muscular contractions. These graduated compresses, carefully made, are particularly serviceable on the battle-field, in gun-shot and punc- tured wounds; by their aid we may arrest ha?morrhage from the radi- al, ulnar, anterior and posterior tibial, and even from the brachial and femoral arteries. In the former or smaller arteries, by leaving the dress- ing on six or eight days, we may arrest the bleeding permanently, but in the latter it only acts as a provisional hajinostatic ; it must be followed by ligation, if we wish to be at all sure of avoiding a recur- rence of the bleeding. We may also emjdoy compression in hasmor- rhages from the thorax, as in case of parenchymatous haemorrhage after removal of a diseased breast; here we may dress the wound with compresses and charpie, and retain them in position by bandages around the thorax. But, for such a bandage to be efficacious, it must be very annoying to the patient; on tlie whole, it is better to ligate the bleeding arteries, even if there should be many of them; by so doing, both you and your patients will be better off, for you will not be worried and disturbed by the secondary haemorrhages following these operations as a result of hasty ligation and insufficient compres- sion. In some parts of the body you cannot employ compresses, as in bleeding from the rectum, vagina, or posterior nares. Here the taiiv- 'pon (from tampon, plug) is serviceable. Tliere are many varieties of tampons, especially for haemorrhage from the vagin.a or rectum. One of the simplest is as follows: Take a four-cornered piece of linen, about a foot square; placing the middle of this over two, three, or five fingers of your right hand, pass it into tlie vagina or rectum, and fill the space left by the removal of your hand Avith as much charpie as you can get in, so that the vagina or rectum will be fully distended from Avithin, and thus strong pressure le made on its Avails; Avhen the haemorrhage is arrested, leave the tampon in till the next da^^, or longer if necessary, then remove it by gentle traction on the linen, A\hich