Case of ligature of the common carotid for hæmorrhage from ulceration of the face / by James Spence, Esq., surgeon.

  • Spence, James, 1812-1882.
Date:
[1843]
Catalogue details

Licence: Public Domain Mark

Credit: Case of ligature of the common carotid for hæmorrhage from ulceration of the face / by James Spence, Esq., surgeon. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    5/8 (page 3)
    BY JAMES SPENCE, ESQ. ^nd pretty full; he complained of pain in the wound on swallow- ana prcit-y luii, f „„H tlip resniration was easy and inff, but there was no cough, and tne respiid,Liu J natural He was ordered some antnnomal solution every second hour^ and half an ounce of caster od m the evenmg, his bowei; had been rather constipated for -me days 3fmj SOtL Continued doing well; P^lfe 98, but soft skm moist.-^ The oil had not been given and his bowels had been moved He was ordered to have the oil, to continue the ant 721, the cold water dressing to the wound, and to have mi 1 diet On the 3ist his bowels had been freely moved ; the pulse was 90 and soft; the skin of natural heat; he had no cough nor uneasiness in the chest, and his tongue was pretty clean i he stitches were withdrawn, and the edges of the wound were found united, except in the immediate neighbourhood of the ligatur^^ where there was a very shght discharge. ^ The former treatment was directed to be continued. The swelhng of the face was con- siderably diminished, and the discharge of more healthy appear- ance ; and, although ulceration of the external ear continued to ex- tend, there had been no further bleeding from the diseased parts. The patient continued to go on favourably till the night ot the 5th of June, when I was summoned to visit him, as a secondary hemorrhage had taken place. Before I saw him the bleeding had been arrested by a gentleman placing the point of his hnger on the wound; but a considerable quantity of blood had been lost previous to this having been done. I separated the recent adhesions between the edges of the wound, whilst an assistant pressed on the bleeding point with his finger. On thus exposing the bottom of the wound, the parts were found m a state evi- dently indicating a want of action; there was no matting of the parts together by effused lymph, as is usually the case in wounds at that period; the muscles and other tissues were pale and easily distinguished; there was no purulent deposit in the wound; the ligature had not completely separated; and the bleeding seemed to proceed from the lower part of the artery. Under these circumstances, it was deemed advisable to apply compres- sion instead of tying the vessel nearer the heart, as it seemed probable that rapid ulceration and secondary haemorrhage would soon follow the application of ligature to the artery. A dossil of lint was placed immediately over the bleeding point, then a gra- duated compress, and the whole secured by several turns of a roller brought obliquely across the neck and under the arm-pits. By these means the haemorrhage was completely arrested. Next day his pulse was 98, and soft, and he felt easy. He was ordered milk diet, and a gentle laxative was prescribed. On the morning of the 8th there was a slight oozing of blood, which stained the bandage; but a fresh compyess was applied, and thus further hajmorrhage was prevented. No more bleeding took place from the wound. On the 14th