The most important of the means of stopping bleeding from wounds is the ligature. This consists in seizing the wounded ends of the artery with a pair of forceps, or passing through it a teutaculutn, and then tying up the artery in the same way that the mouth of a full sack is usually tied. For this operation all the skill that is required is ana tomical knowledge. Care should be taken, whilst the necessary instru ments are being prepared, that the bleeding is prevented by pressure on the truck of the artery, or by placing the finger over the bleeding orifice itself. The forceps which are mostly used on this occasion are the common dissecting forceps, but Mr. Liston recommends a pair of forceps with hooks at their points, and which, after having grasped the artery, are kept together by means of a button or hook. " When no assistant is at hand, and in cases of emergency, the surgeon provided with this little instrument, can tie vessels without the least difficulty ; and in operations, when many vessels spring, several of these forceps can be applied : there is, besides, this great advantage in their em ployment, that a clumsy assistant can scarcely include the point of the instrument with the vessel" (Liston.) The immediate effect of a tightly-drawn ligature is to arrest the flow of blood, to divide the middle and internal coats of the artery at the ligatured part (the exter nal sheath remaining entire), and to narrow the canal for some extent above the ligature. The same process of cure goes on then as when the artery heals spontaneously.
Other means of arresting haemorrhage are sometimes employed, such as the application of styptics [AsTinseesars], sponge, the actual cautery, wustice, ite. These, however, are seldom advisable iu the case of in cised wounds. There is, however, a popular prejudice in favour of applying various styptics to cuts for the purpose of stopping the bleeding, and it cannot be too generally known that all these applica tions aro injurious, and tend to retard the cure ; and that in some instances loss of life is the consequence of these applications to wounds that would have got well had they been left to themselves. [Iliesto DAMAGE; ARTERY ; HEART.] The second indication in the treatment of incised wounds is the removal of foreign bodies. Unless all extraneous substances are removed from a wound, its union will not be effected, and suppuration, abscesses, and perhaps sloughing, will occur. It is in gunshot wounds that this indication requires the greatest attention, but foreign bodies are occasionally introduced into incised wounds. [OessuoT Womsos.] Wounds from broken china, glass, and earthenware frequently have fragments of these substances in them. Sharp Instruments are fre quently covered with dirt and various impurities; hence the import ance of cleaning even incised wounds. John hunter advocated the
leaving blood on the edges of the wound, as he supposed it was the blood that became organised and united the wound ; but this is now found to be erroneous, and all surgeons advocate the practice of removing as much of the blood as possible from the wound.
The third indication in the treatment of incised wounds is to bring the edges of the wound together, and to retain them so in such a man ner as shall favour their speedy union. Wounds may unite in two ways—either by the establishment of an inflammation, the result of which Is the secretion of pus, and the formation of what are called granulations, or the throwing out from the wounded parts coagulable lymph, which, becoming organised, unites the edges of the wound together. This latter process is called union by the first intention, and should be the great object of the surgeon in treating wounds. Evident as it may appear, that to heal a wound as quickly as possible should be the great object of the surgeon, this universal rule amongst English surgeons is objected to by some continental writers of the present day.
It was at one time supposed necessary that wounds should heal only after a long and tedious process of cure by granulation, and lint and tow, bandages, compresses, and a variety of other appliances were made use of to prevent nature from effecting the object in her own way. The remnants of this practice are still found amongst the popu lace in our own country and some surgeons on the continent. Amongst the latter, M. Roux, of Paris, has distinguished himself by advocating the cure of wounds made in surgical operations by bringing on the tedious process of granulation.
• When the blood has ceased to ooze from the sides of a wound, an effusion of lymph takes place of a plastic character. Into this lymph vessels are projected by the process of growth from the sides of the wound, and an organised union of the whole wound will frequently take place in the course of forty-eight hours. Even the extent of sur face laid open by amputation of the thigh is often securely united throughout its whole extent in the space of seventy-two hours. So readily does this process occur, that there are many instances on record of parts of the body having been totally severed, and yet union by the first intention has taken place. Garengeot, in his Traite des Opera tions,' mentions a case in which a soldier's nose was bit off by one of his companions, and, being restored to its natural position immediately, a permanent union of the separated part was effected. Fioraventi, Blegny, Balfour, BOMB, and others, have also recorded instances of the restoration of entire union of parts after total separation by accident.