GLTNSIIOT WOUNDS. —In a gunshot wound the bullet may cause merely a contusion, it may cut the artery com pletely across, giving rise to considerable haemorrhage, or, if it injures the neigh boring vein also, an ancurismal varix may result. This subject has been con sidered in the various departments in which wounds and injuries have been described. (See ABDOMEN, INJURIES OF, volume i, etc.) the constitu tional treatment already referred to, cold in the form of ice, or heat in the form of hot water of about 120° F., locally ap plied, often causes arrest of haemorrhage. Heat is to be preferred, however, as it has no depressing action upon the pa tient.
Pressure, which is often of value, may ' be applied by means of the finger, by compresses secured by bandages to the bleeding-point or over the main artery, or by a compress placed in the flexure of a joint held fn situ with a bandage. The latter methods must be carefully watched, as the venous return is inter fered with and oedema of the part may arise. Care must also be taken not to bandage so tightly as to cause gangrene. If the actual cautery is used, it must be .a very dull red, otherwise it burns away the tissues, and bleeding returns when it is removed. Styptics should seldom or never be used.
In many cases acupressure is of great value. A harelip-pin or needle is passed. through the skin perpendicular to the artery, then under the latter and out through the skin on the opposite side, when a figure-of-eight ligature is thrown around the ends of the pin. Another
method consists in introducing the pin or needle through the skin parallel to the artery, then rotating it until perpendicu lar to the artery, when it is carried across and in front of the latter, to be deeply inserted into the tissues of the opposite side.
When torsion is used in the treatment of hemorrhage, it is accomplished by catching the end of the cut artery with a pair of forceps and twisting it two or three times until there is no sense of resistance. Care must be exercised not to twist the end off. This method is applicable only when the vessel is en tirely cut across.
Ligation is one of the best methods of controlling haemorrhage from an artery. Silk or catgut ligatures are to be pre ferred and must be aseptic or antiseptic. If the hemorrhage is primary and bleed ing has ceased, no ligature is needed. When, however, the vessel is still bleed ing the surgeon should search for it in the wound and when found should apply a ligature to both ends if the artery is cut entirely across and to both sides of the wound when the vessel is only par tially severed. If the distal end cannot be found, the proximal end is to be tied and a compress placed over the wound. In some cases it is impossible to tie the bleeding vessel in the wound and liga tion in continuity must be resorted to.