512 OPERATIONS ON THE CIRCULATORY SYSTEM. 



will be no more than a wise precaution to apply a second ligature 

 below the clot, to prevent the possibility of the escape of suppura- 

 tive matter into the general cu'culation. The material of the 

 ligature may be either ordhiary linen cord or silk. Our own pref- 

 erence is for sterilized catgut. The resulting wound is treated in 

 the manner proper for all similar wounds, and in from twenty to 

 twenty- five days complete recovery may generally be looked for 



4th. Wound of the Carotid. — This compHcation of phlebotomy 

 at the jugular is not of common occurrence, but is easily possible. 

 It may become one of the consequences of using a fleam unneces- 

 sarily large, and out of proportion with the dimensions of the vein 

 and the thickness of this skin ; or it may be caused by the exhibi- 

 tion of needless violence, in striking too heavy a blow with the 

 bleeding- stick. Nor are these the only causes to which wounds of 

 the carotid may be referred. An abnormal anatomical disposition 

 of the artery, either permanent or temjsorary, may cause it to re- 

 ceive the wound designed for its neighbor the jugular. 



The symptoms pertaining to this accident are very character- 

 istic. The color and volume of the blood, and the rapidity of the 

 per saltum flow of the stream are sufficient evidences of the 

 arterial and non-venous source of the hemorrhage. Concurrently 

 with this, a swelling takes place around the edges of the wound, 

 increasing with greater or less rapidity, and nearly resembling the 

 ordinary thi'ombus of venous extravasation, though dififering from 

 it by the rapidity of its formation. 



This false aneurism is now subcutaneous, and has a tendency 

 to extend itself downward toward the lower part of the neck, and 

 has, indeed, been found extending as far as the entrance to the 

 chest. 



This accident is generally one of a serious nature, not alone 

 in itself, but often because of the specific manipulations which it 

 necessitates in order to overcome it. There are, however, several 

 fatal cases on record. The indications of treatment may be either 

 quite simple, or, at times, of serious import. If the puncture of 

 the artery is but a small one, and the flow not abundant, one or 

 two strong pin sutures may be sufficient to control it, esjjecially if 

 associated with it steady and firm pressure is estabUshed du-ectly 

 upon the com-se of the vessel, either by compressive bandages, or, 

 what is better, with the fingers firmly pressing in the jugular 

 groove. If, however, the wound is large, and accompanied by a 



