Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • John Eric Erichsen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

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

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    buckled with sufficient tightness to keep it in its place ; but the instrument should not be screwed up until the moment of the operation. It should then be tightened rapidly, so as to avoid as much as possible the congestion of the limb that always occurs when a tourniquet is applied. The first cftect of the tightening of the tourniquet is to compress the large veins ; the second, to arrest the flow of blood through the arteries : hence the more slowly it is screwed up the greater will be the venous engorgement of the limb. The blood that flows from the limb during an amputation, when the tourniquet is applied as above described, is almost entirely venous, coming from the lower part of the member, A screw tourniquet may be equally well applied without a pad (Fig. 12) : but it is then necessary to put a piece of card, folded paper, or leather, beneath the screw to save the skin from being pinched. The pad has the disadvantage of being liable to slip, and if not very accurately applied, it tends rather to protect the artery from pressure than to compress it. The screw tourniquet is now almost abandoned in favour of the simple elastic band. It is, however, a useful instrument when the Surgeon is short of skilled assistants, and especially in wounds of large arteries, in which an occasional relaxation of the tourniquet is required to guide the operator to the injured vessel. Compression by Elastic Tub- ing or Bandage.—The circulation through a limb may be completely arrested by two or three turns of an elastic bandage appHed with mode- rate firmness. The bandage may then be secured by a knot or by a pin. During the Franco-German War, the field tourniquet served out to the German army consisted of nothing more than a narrow elastic bandage about one inch in width and three feet long. Esmarch, of Kiel, introduced as a substitute for the bandage, a piece of india-rubber tubing about three-quarters of an inch in diameter and two feet in length, having a hook fixed to one end and an eye to the other. This is stretched and wound firmly and rapidly round the limb two or three times. It often happens that the hook does not meet the eye exactly as it is wanted to, so that either an extra turn of the tube must be put round the limb, or the former turns must be unduly relaxed. This may be obviated by replacing the hook and eye by two pieces of stout tape, bound on to the ends of the india-rubber tube. The tube can then be applied with exactly the amount of force required, and secured by tying the ends of the tape together. It must be remembered that in applying the band, enormous pressure is easily obtained by a few turns one over the other, so much so, that in situations in which the chief nerves lie very close to the bones, as in the arm, syni])toms of paralysis, sometimes lasting for weeks, are recorded as having resulted from its use. Such accidents are more likely to occur if the narrow tube is used, than if the constriction be made by an elastic bandage. The latter should therefore be preferred where it can be conveniently ajjplied. - Fig. S.—Esmarcli's Toiuniiquet applied to Slioukler.