SURGERY. 



463 



the wound is a very large one, such stitch will be 

 sufficient for any wound of the lips. The sides of 

 the wound are to be pressed together, and tied with 

 a double knot on the surface of the wound. It is 

 best, however, to have four needles and two 

 ligatures ready; and if a second stitch is taken, it 

 should be at least half an inch, and in most cases, 

 an inch, from the other. A narrow slip of adhesive 

 plaster is then to be applied over the space between 

 the stitches, reaching an inch beyond the edge of 

 the wound, on each side, and another broad slip, 

 with notches in the sides, placed in the longitudinal 

 direction of the wound, and over the end of those 

 slips which were placed across. A piece of linen 

 rag or caddis, covered with spermaceti ointment or 

 Turner's cerate, should cover the stitches and other 

 dressings, and the whole be secured by a soft hand- 

 kerchief, properly applied, so as to keep all in its 

 place. 



There is another branch of domestic surgery, 

 and perhaps the most important with which any 

 unprofessional individual can be acquainted, and 

 this is stopping an hemorrhage or discharge of blood 

 from any of the great arteries or blood vessels when 

 they have been divided or wounded by disease or ac- 

 cident. By the knowledge of this many useful 

 lives have been saved, as a wound of the principal 

 artery, for example, of the thigh or arm, if not 

 speedily checked, would in the course of perhaps 

 less than ten or fifteen minutes prove fatal. 



There is an instrument employed by surgeons for 

 checking the bleedings, called the tournequet, of which 

 there are two descriptions (see Plate LXXX VII. figs. 

 1 and 4.) ; the first used in cases of amputation, to 

 prevent the discharge of blood during that opera- 

 tion, and consists of a brass screw of considerable 

 power, a bandage and small pad or cushion, resem- 

 bling a small pen cushion and buckle. The bandage 

 is from an inch to two inches in width, according as it 

 may be'tequired, in greater or less extremities, and 

 the size of the other parts are reduced accordingly. 

 (See it applied to the thigh, Plate LXXXVI. fig. 10.) 

 The more simple tournequet is called &field tournequet, 

 (fig. 1,) because it is carried to the field of battle not 

 only by the surgeons and assistant surgeons, each of 

 whom are supplied with a number of these instru- 

 ments, and likewise by officers, and occasionally 

 even private soldiers, who, by a prompt application 

 of this simple instrument, have saved their own 

 lives or those of their wounded companions. The 

 field tournequet consists of a small turned wood 

 handle, often about four or five inches in length, 

 sometimes a small pad and piece of thick leather 

 about the size of a crown piece, and a bandage 

 about an inch or an inch and a quarter in width. 

 This bandage is placed round the wounded limb, 

 about an inch or two above the wound, and tied. 

 The handle is then turned round over above the 

 piece of leather, with a compress below it, imme- 

 diately in the line of the bleeding vessel, which 

 may be discovered by observing that part of the 

 limb from which the bleeding proceeds, and by 

 the turning the handle the bandage is tightened and 

 kept in its position in the same way as carriers or 

 carmen secure the rack pins of their loaded carts or 

 wagons. 



An attentive reader and observer will perceive, 

 fioin the plate, the mode in which the screw tourne- 

 quet is applied, is somewhat similar a manner, only 

 the screw is employed to tighten and retain the 

 bandage in its proper state in place of the wooden 

 handle in the other case. In many cases, however, 



of accidents of the extremities (for it is to the ex- 

 tremities that the tournequet is chiefly applied) 

 neither of these useful instruments are to be pro- 

 cured in time, and the patient dies of hemorrhage. 

 A substitute is, however, in general easily procured, 

 and any individual who is at hand may entirely 

 suppress, or at any rate greatly moderate the dis- 

 charge of blood, till a surgeon arrives either to 

 amputate the limb or tie the bleeding vessel ; for 

 oftentimes the wound is so extensive as to require 

 almost immediate amputation. Let a stout hand- 

 kerchief, or a brace or suspender, which is generally 

 made of stout cotton or silk web, be tied firmly 

 about an inch and a half above the wound, and as 

 we have marked the places in the arm, leg, or 

 thigh, the part most proper for making the pressure 

 may be easily understood. When an artery is 

 wounded it is easily to be distinguished, as the 

 blood flows out by jirks, and not in the slow, con- 

 tinued stream, as from a vein, and the arterial 

 blood is of a bright red colour, while the venous 

 is darker. If one of the large arteries of the thigh 

 is wounded more than halfway up, it will require 

 a much greater force to stop the bleeding than if 

 lower down, or even in the leg or arm ; but the 

 same rule is applicable to all cases of great hemorr- 

 hage from the blood vessels of the lower and 

 upper extremities. 



On this point we feel a deep interest, as we 

 have known more than one or two instances of 

 persons bleeding to death from even what appeared 

 to be trifling wounds of the wrist or ankle, and 

 which any boy, or indeed girl, or the patients 

 themselves might with a knowledge of the above 

 rules easily have checked. 



Where the small branches of the arteries that 

 supply the fingers and toes with blood conjoin, 

 sometimes such a discharge occurs as to injure 

 an individual of delicate constitution ; but the 

 operation of tying the vessel in order to stop the 

 bleeding is seldom, perhaps never, required. In 

 order, however, to allow time for the requisite 

 dressings to be procured and applied, a tight ban- 

 dage of narrow tape or ribbon may be fastened a 

 little above the wound. Agaric, properly pre- 

 pared, may be then applied to the wound, after it 

 has been spunged and cleaned, and the dry agaric 

 sometimes acts mechanically as a plug to the 

 bleeding vessel, although it possesses no specific 

 styptic or astringent property, as was once believed. 

 Clean cobwebs, when applied in the same way, and 

 in sufficient quantity, sometimes succeed as a plug, 

 and they are not in general difficult to procure ; 

 but perhaps the best dressing for such a wound, 

 although it has been getting out of fashion, is a 

 compress of fine linen rag, or caddis, several times 

 folded, moistened with the compound tincture of 

 benzoin, or friar's balsam, and secured by a pretty 

 long narrow calico bandage. When this has been 

 applied, the ligature above the wound may be re- 

 moved, and if the bleeding returns, continue to 

 moisten with the tincture or balsam, which, uniting 

 with the blood, will soon furnish a plug to the 

 arterial twig. The wound should not be again 

 dressed in less than four or five days. The great 

 art, however, in stopping a bleeding of this kind is 

 making a firm and equitable pressure over the 

 moistened compress; but it should be borne in 

 mind, that the ligature directed to be tied above 

 the wound is to be kept no longer on than the 

 wound is dressed or than the compress is applied, 

 ' and not so tight as entirely to check the circula- 



