If, on the other hand, in spite of the treatment, the bleeding continues, the pressure must be re-applied, and the cut ends of the bleeding vessel looked for in the wound itself, and either twisted or tied with a silk ligature.
Fig. 3.—Method of Compressing the Main Artery of the Thigh.
To twist a vessel, seize the bleeding point between the blades of the artery forceps, then, by twisting the instrument round three or four times, the vessel will become blocked or closed, and the forceps may be taken off in the course of ten minutes. The other method is to tie the vessel with a silk ligature (previously boiled), making a reef or sailor’s knot, to cut short the ends of the ligature, remove the forceps, and let the vessel fall back into the wound. In any case cleanse the wound, and dress in the manner previously described.
The traveller who has taken the trouble to learn something about the treatment of wounds and severe hæmorrhage will, before his journeys are ended, probably have opportunities of saving the life of a comrade by his skill. Nothing can be more distressing than to see a man die from a hæmorrhage which anyone who has studied the subject a little would be able to control in nine cases out of ten without much difficulty. I therefore earnestly urge all travellers to gain as practical a knowledge of this subject as is possible, before leaving a civilised country.
After-Treatment of Wounds.
A clean-cut wound, which has been completely closed and properly dressed, need not be dressed again until the fourth day; and the stitches need not be removed for seven days.
On the other hand, a ragged or dirty wound, or one in which it has been necessary to insert a piece of gauze for the purpose of drainage, should be syringed out and dressed daily from the first.
The important index to the state of a wound is the patient’s temperature. If, on the third day after the wound was first dressed, the temperature is normal, and subsequently remains so, the wound is probably healing well; but if the patient’s temperature is up to or beyond 100° F., and the part is painful, there is probably some inflammatory change going on in the wound. The dressings should be taken off, and the wound examined. If the surrounding skin is red and shiny, and the limb swollen and tender, some of the stitches should be taken out, and the wound well syringed with an antiseptic lotion. This, with a good purge, such as calomel or Epsom salts, will probably remove all signs of inflammation; but still the wound must be dressed daily. If, however, the temperature still remains high, 100° to 101° F., or more, and the patient is restless and light-headed, all the stitches should be taken out, the wound opened up, and hot fomentations, prepared with an antiseptic lotion, applied every four hours till the temperature comes down. Tonics of quinine and iron should be given.