HEMORRHAGE
May be primary or secondary. In the first instance it occurs in consequence of the insufficiency of the means of hemostasis applied to the end of the cord, as in the case of the operation by simple excision, by cauterization, the too rapid crushing of the cord, torsion, or the accident before referred to—when the clamps have been torn off and the cord lacerated about the point of their application.
Secondary hemorrhage manifests itself after a longer interval following the operation. It may occur, for example, after the removal of the clamps, or when, during their removal, the mortified end of the cord is too much interfered with by the sharp end of the instrument used in cutting the string which confines them together, or from too forcibly pulling upon the cord itself; and in some instances without any assignable cause other than a diseased condition of the coats of the artery. This secondary hemorrhage is usually, by reason of the inflammatory condition of the blood vessels, of more threatening aspect and more difficult to control than the primary variety. The treatment indicated varies. When caused by the tearing of the clamps, or at the time of their removal, it may be checked by the reapplication of the instrument. But if the cord is retracted within the inguinal canal and cannot be reached, and if it is already adherent to the surrounding tissues, by granulations recently formed, the checking of the flow may be very difficult. In many cases the application of cold water, either in the shape of the cold douche over the part, or iced sponges, may prove sufficient. But in other cases the cavity of the wound must be packed with balls of oakum, wet either with water alone or any styptic agent, such as a solution of perchloride of iron, the whole being kept in place by a suspensory bandage, or if necessary, a few points of suture.
These measures may be put in practice while the animal is on his feet; but if they fail in their effect, the surgeon must at once proceed to cast his patient and ligate the artery—an operation of delicate execution, and not always easy to perform, by reason of the deep seated position of the vessel. The use of the actual cautery has also been recommended, but even when successful there are many objections to this, one of which is the complication such an operation may bring on by the introduction into the wound of a scab which must necessitate for its expulsion a serious amount of inflammatory action. As a rule, however, the operation of packing is all that is required, the oakum being left undisturbed for twenty-four or even thirty-six hours. Its removal must be undertaken with great caution.