Notes of cases illustrating surgical lesions of the vascular system / by Rudolph Matas.

  • Matas, Rudolph, 1860-1957.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Notes of cases illustrating surgical lesions of the vascular system / by Rudolph Matas. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    30/35 (page 24)
    i a I \ OBSERV^TION lo.—Punctured and incised wound of the super- ^ ficial and deep palmar arches. Wound soiled by cob- ] webs and perchloride of iron. Great prostration and acute i anemia from excessive bleeding. Anesthesia, careful ! washing of the wound ; bleeding points secured with hemos- | tatic clamps; iodoform tampon in wound. The limb im- mobilized by long extensor and flexor splints and aseptic dressing. Removal of the hemostats in three days fol- lowed by complete healing by granulation. In November^ 1892, the patient, a robust male, set. 36, while clumsily opening an oyster with an unusually sharp knife transfixed the left palm through and through, so that the rounded end of the knife appeared on the dorsum between the third and fourth metacarpals. Profuse bleeding followed, which indi- cated that an important vessel had been injured. He was brought to a neighboring drug store for assistance, but a hand- ful of cob-webs had been applied in the meantime over both bleeding orifices. The druggist applied a compress of lint soaked in perchloride of iron and then bandaged the hand. This temporarily checked the bleeding, but in a few hours the hemorrhage recurred, soaking through the bandage, the blood soon dripping to the floor. When I saw the patient late at night, I found him exceedingly weak, with a small, rapid pulse. There was great pallor, nausea and inability to sit up. After the administration of aromatic spirits of ammo- nia, digitalis and brandy, I unbandaged the hand and applied an Esmarch bandage. A mixture of equal parts of chloroform and ether was administered and well taken by the patient. The whole hand was dipped into a bowl of hot carbolized water and scrubbed until the hard perchloride clots and cob- webs had been washed away. The palmar wound was then freely enlarged on a line cor- responding to the long axis of the medius and its metacarpal until the deep tendons were exposed. It was evident that both the superficial and deep arches had been injured, and that it would not be an easy matter to discover the bleeding points in the midst of the stained tissues. Nevertheless, after freely ex- posing the whole depth of the wound, the constrictor was re- laxed and the point from which the blood spurted at the bottom