Hand-book of surgical operations / by Stephen Smith.

  • Stephen Smith
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Hand-book of surgical operations / by Stephen Smith. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    CHAPTER II. ON THE ARTERIES. AVOUNDS OF ARTERIES. Arteries may be contused, lacerated, punctured, and incised. Contused Wounds.—An artery may, without any apparent lesion of its coats, be so contused as to lead to its permanent contraction; this injury is liable, in connexion with concurrent injuries, to ter- minate in gangrene. Sloughing of the coats may occur. Lacerated Wounds.—Lacerated wounds of arteries are met with under the following forms:—1. The internal coats of an artery may be ruptured without a lesion of the external coat; 2. The exter- nal coats may be lacerated without a lesion of the internal coat; 3. All the coats may be torn through. The two first accidents to arteries may lead to the following results:—1. To the obliteration of the vessel in the same manner as when the ligature is applied; 2. Severe haemorrhage from the sloughing of the remaining coat; 3. To an aneurismal tumor formed by the gradual yielding of the remaining coat; 4. To immediate obliteration of the artery and gangrene of the limb. The third lesion, or rupture of all the coats, is liable to be followed by gangrene, especially when the accompa- nying vein is also involved; haemorrhage seldom occurs. Punctured Wounds.—Arteries may be penetrated by large or small instruments; when the instrument is very small, as a needle, the wound may heal without any haemorrhage or other symptom; if the instrument is larger, haemorrhage may be immediate, or the elasticity of the coats may close the wound temporarily, and sub- sequent ulceration reopen it, resulting in free bleeding. Incised Wounds.—The incised wound may partially or wholly divide the vessel; it may be transverse, oblique, or longitudinal to the axis of the vessel. When the vessel is completely divided it is much less liable to continued and repeated haemorrhage thau when partly divided, as it is capable of contraction and retraction, which favors the formation of a clot. Partial division of an artery by a transverse or oblique wound is constantly liable to hemor- rhage ; if the clot forms externally, which is always the case it is readily displaced and the bleeding is renewed. Longitudinal wounds are capable of spontaneous cure. Treatment.—The following genera] and special rules in flu; treat- ment of wounded arteries, are principally from Mr. Guthrie- slight modifications have been made:— General Rules.—1. If the wounded artery is in an extremity the haemorrhage may be temporarily controlled, either by strongly