Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands / from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.

by G. J. Guthrie

A soldier, who had his arm carried away by the bursting of a shell at the siege of Ciudad Rodrigo, was brought to me shortly afterward. The axillary artery, becoming brachial, was torn across, and hung down lower than the other divided parts, pulsating to its very extremity. Pressed and squeezed in every way between my fingers in order to make it bleed, it still resisted every attempt, although apparently by the narrowest possible barrier, which appeared to be at the end of the artery, and formed by its contraction. The orifice of the canal was marked by a small red point, to which a very slight and thin layer of coagulum adhered, the removal of which had no influence on the resistance offered by the very extremity of the artery to the passage of blood through it. In this, and in another instance of a similar nature, the end of the artery being cut off at less than an eighth of an inch from the extremity, it bled with its usual vigor. In both, the vessel for near that distance was contracted so as to leave little or no canal at its orifice, which in these cases was filled by a coagulum of the size and shape of a very small pin.

1. Axillary artery.
2. Axillary vein.
3, 3. Branches of axillary plexus of nerves.
4. Curved, pointed and plugged ends of the artery and vein.

The vessels are here represented as they lay exposed in the lacerated parts. The pointed and plugged ends of the vessels were of a dark coagulum color, while above both artery and vein had a reddish, vascular appearance, and were held in close relation by their sheath. The artery bent distinctly to the very base of the coagulum.

Mr. Deputy Inspector-General Taylor informs me that a soldier of the 44th Regiment was struck by a cannon-shot on the 21st of June, 1855, in front of Sebastopol; it carried his left arm away from the shoulder, leaving the artery, vein, and nerves exposed as in the accompanying sketch. The thought, he says, crossed my mind, as I held the artery between my finger and thumb, that it might be for the benefit of the patient to place a ligature on the artery at the highest point, exposed, cutting off the part below, having had a precisely similar case at Ferozeshah, in India, in which the soldier recovered without the artery being tied, or any hemorrhage recurring. The shot, in carrying away his arm, struck him very severely on the chest, and I fear has injured the lungs, but there is so much ecchymosis that the presence or absence of sounds cannot be distinguished by the stethoscope. Of this injury of the chest the man died some days after its receipt. The body was buried without examination, but no hemorrhage had taken place from the wound.

Private J. Barnes, 29th Regiment, on the 16th of May, 1811, at the battle of Albuhera, received a musket-ball in the right thigh, behind and above the knee, inclining downward and inward, close to the condyles of the femur, and in the direction of the femoral artery becoming popliteal; it bled violently at the moment, and so continued for a few minutes, during which time he conceives he lost two quarts of blood. It then ceased, and he was dressed in the usual slight manner, and remained two days upon the field of battle, until removed to Valverde, nine miles, on a bad road, on men’s shoulders, in a blanket converted into a bearer. He was considered as one of the slighter cases, until the gentleman in immediate charge of him requested me to see him, on account of his toes being in a state of mortification.

On the evening of the 3d of June, eighteen days after the accident, the man was placed on a bullock car, to be removed with the rest of the wounded to Elvas, the mortification of the foot having ceased to increase, and a line of separation having been formed. Shortly after the cars moved, I was informed that he was bleeding from the wound: it evidently appeared to flow from the popliteal artery; and as it issued slowly, I supposed from the lower divided end. The foot being partly lost, I determined on amputation above the knee, which was performed at Olivença. The amputated limb was sent after me to Elvas, that it might be examined at leisure. I carefully traced the course of the wound, and found in it a little coagulated blood, but could not see the mouth of the vessel. A probe passed into the upper end of the artery was obstructed before it reached the ulcerated surface by nearly an inch; and on passing it up the lower one, it was stopped exactly in the middle of the track of the ball, by a veil or substance drawn across the mouth of the vessel, which, on careful examination, showed the point of the probe at one part of the circle, although too small to let it through; from this part I conceive the hemorrhage came. The divided ends were one inch apart. The upper, or femoral portion, for nearly an inch, contained a firm coagulum, filling up that part of the artery, which had contracted like the neck of a claret bottle. The lower or popliteal portion of the artery had a very peculiar appearance; the substance drawn across appeared to have closed it completely at one time, and to have given way from the rough motion of the car at the point now open, which was very small even when the sides of the artery were approximated. A very little soft coagulum was behind it; and if the man had not been removed, the vessel might have remained secure. This case shows very distinctly the means adopted by nature for the suppression of hemorrhage from both ends of a divided artery.

Corporal Carter, of the pioneers of the 29th Regiment, was wounded at the battle of Roliça, in August, 1809, by a musket-ball, which passed through the anterior and upper part of the forearm, fracturing the ulna. Shortly afterward a profuse hemorrhage took place, and the staff-surgeon in charge tied the brachial artery. In the night the hemorrhage recurred, and the man nearly bled to death. The arm was then amputated, when the ulnar artery was found in an open and sloughing state.

Remarks.—A simple incision to expose the wounded artery, and placing two ligatures upon it, would have saved this man his arm and his life.

At the battle of Vimiera, which followed a few days afterward, a soldier received a somewhat similar wound, save that the brachial artery bled forthwith, the hemorrhage being stopped by the tourniquet. Warned by the preceding case, I cut down on the artery, carefully avoiding the nerve, which had been tied in the former instance, and found the artery more than half divided. It was secured by a ligature above and below the wound: the bleeding did not afterward return, and the man recovered.