MILITARY SURGERY AND MEDICINE 



537 



arrest of this hemorrhage before it has produced 

 serious prostration is a matter of the first im- 

 portance. For this purpose the use of some 

 form of the tourniquet has been most generally 

 advised. In the absence of the forms usually 

 employed by the surgeon, an extempore tour- 

 niquet is often improvised from a handkerchief, 

 cravat, or pair of suspenders, a knot being placed 

 over the wounded blood-vessel and the whole 

 twisted tightly with a stick. If the wounded 

 vessel bleeds in jets and the color is a bright 

 red the tourniquet is placed above the wound ; 

 if the blood is dark colored, below. The dis- 

 advantage of these extempore tourniquets, and 

 indeed of most of those provided by the surgi- 

 cal instrument-makers, is that in unskilful hands 

 there is danger of ligating the limbs too tightly 

 and cutting off the circulation of blood in the 

 limb through the anastomosing vessels, so as to 

 produce serious ulceration and pain, or even 

 sometimes paralysis of the limb. A field tour- 

 niquet (Jig. 1) recently invented by Dr. Alex. B. 

 Mott, ingeniously avoids this difficulty. His in- 



FlG. 1. 



Mott's Tourniquet 



otrument consists of two ribbons of metal, to 

 one of which a small pad is attached, and which 

 aie connected together by straps of webbing 

 at each end riveted upon one and attached to 

 the other by means of a buckle. By this appa- 

 ratus no pressure is made upon the limb except 

 at two points, over the vessel and at a point 

 directly opposite, the lateral blood vessels be- 

 ing free to maintain the circulation and life of 

 the limb. Tiemann's tourniquet (Jig. 2) ac- 



Tiemann's Tourniquet. 



complishes the same purpose very well, though, 

 perhaps, with some liability to injurious pres- 

 sure, if carelessly applied. 



The use of powerful styptics, such as the per- 

 sulphate orperchloride of iron, or the compound 

 alum styptic, to arrest hemorrhage by produc- 

 ing instant coagulation of blood in the wounded 

 artery or vein, has been recommended by some 

 surgeons, and soldiers were advised to carry a 

 small bottle of some of these styptics with them ; 

 but the most eminent military surgeons disap- 

 prove of their use in wounds of the limbs 

 wherever the tourniquet can be substituted 

 for them, as their use is almost invariably fol- 

 lowed by extensive sloughing and ulceration, 

 and they are often unsuccessful in checking the 

 hemorrhage, forming only a huge clot, which, 

 falling away after a short tune, leaves the orifice 

 larger and the hemorrhage more profuse than 

 at first. In wounds of portions of the head, 

 face, or neck, or superficial wounds of the trunk 

 involving large blood-vessels, or such as might 

 occasion too severe loss of blood, the styptics 

 are used with advantage, a piece of lint being 

 saturated with the solution, and laid over the 

 bleeding orifice, and a larger pledget of dry lint 

 or a piece of cloth folded, placed over this and 

 moderate pressure being applied for a few min- 

 utes to retain it in place. Uniform and moder- 

 ate pressure with a roller bandage properly 

 applied will generally close sufficiently all the 

 smaller vessels, and materially diminish the 

 danger of further bleeding from the larger ones. 

 In the field-hospitals, however, there is so much 

 difficulty in the proper application of the roller 

 bandages, that they are seldom used, a piece of 

 cloth or lint wetted in cool water being the 

 usual application. 



The transportation of the wounded soldier 

 from the battle ground to the field-hospital, as 

 well as to the more remote camp, post, or gen- 

 eral hospital, is a matter of importance. If 

 roughly and unskilfully performed the wounded 

 man not only suffers severely but his injuries 

 may be rendered mortal. At first it was the 

 practice in the army for the line officers to de- 

 tach two men who were uninjured from the 

 ranks to bear off each wounded man, but this 

 weakened the force so much in a severe battle 

 (the bearers seldom returning to their place), 

 that it was finally prohibited, and only the am- 

 bulance men of the regiment, or the members 

 of the band, aided sometimes by the chaplain, 

 or by civilians, assisted in that duty. An am- 

 bulance corps was organized in connection with 

 the Army of the Potomac in the autumn of 1862, 

 but did not attain much efficiency till the spring 

 of 1863. Congress, at its session of 1863-'4 

 extended its provisions to the other armies of 

 the republic. By its provisions each regiment 

 in going into battle is entitled to three ambu- 

 lances, with their drivers, and six stretcher- 

 bearers, who are commanded by a sergeant, the 

 stretcher-bearers marching with the regiment 

 into battle, and the ambulances being drawn up 

 in rear between the army and the field-hospital ; 

 the ambulance force of the regiments forming 

 a brigade, being under the command of a second 

 lieutenant, that of a division being commanded 



