AY OGASEFOP ILIGATURE OF THE BRACHTAL ARTERY, 
ILLUSTRATING THE PERSISTENT VITALITY OF 
THE TISSUES 
[Edinburgh Medical Journal, vol. iv, p. 119, August 1858.] 
ON the 28th of May last I was requested to see a case at Balfron, in Stirling- 
shire, under the care of Mr. Burgess, who stated that on the roth of April the 
patient, a man about fifty years of age, inflicted a suicidal wound with a razor 
on the front of the left arm about three inches above the elbow, severing the 
biceps completely and dividing both the main superficial veins of the limb. 
The bleeding was very profuse but chiefly venous, and was readily controlled 
by pressure, and the wound was afterwards lightly dressed without anything 
unusual occurring for several days, when haemorrhage again took place to 
a very alarming extent. It was treated as before by compression, but recurred 
twice at intervals of a few days, after which for a period of more than three 
weeks the healing process appeared advancing favourably. On the 24th of May, 
however, there was another discharge of blood from the wound, and this was 
repeated at frequent intervals and with increasing violence in spite of com- 
pression, until the 27th, when it became imperative to have recourse to other 
measures. Inconvenience in the arrangements of the railway delayed my 
arrival nearly a day, and in the meantime it had been found necessary to apply 
bandages at the seat of wound with all possible force, so as completely to arrest 
the flow of blood through the vessels of the limb, which had thus been entirely 
devoid of circulation for about thirty hours before the time at which I first 
saw the patient, viz. 2 p.m. on the 29th. At this time he was lying in bed pale 
and weak from loss of blood with the left arm somewhat swelled below the 
bandages, livid in tint and quite cold. Chloroform having been administered 
I removed the bandages, after which arterial blood gushed from the wound as soon 
as ethe pressure of the fingers over the brachial artery was relaxed. With the 
assistance of Mr. Burgess I proceeded to expose the bleeding-point, and after 
a somewhat troublesome dissection among the tissues, densely matted together 
with inflammatory deposit, discovered a small wound in the brachial artery, 
and having cleared the vessel sufficiently to avoid the risk of including either 
of the adjacent nerves, passed ligatures around it above and below the aperture, 
with the effect of removing all tendency to haemorrhage. Before I left in the 
