72 WOUNDS AND BRUISES. 



to the heart, with a torsion forceps, draw it out, and give it about 

 ei^rht half twists, so as to form a twisted coil or knob that will aid 

 in securing the vessel. If a ligature be used, it should be tied 

 tightly by a reef knot (Fig. 32), with thread : silk for preference. 

 We may then pick up and tie the other end. An attempt to twist 

 or tie should always be made, when there is persistent bleeding in 

 a jet. Bleeding from an artery may be often stopped by getting 

 hold of the cut end from which blood is being pumped out, with the 

 fingers, and exerting pressure on it for a few minutes ; or by keeping 

 up pressure on the side of the cut end with the finger, or a pad 

 (p. 66). 



" Above all, the surgeon should never dread hcemorrliage, nor lose his 

 presence of mind when it occurs. If recour.se be had to proper means, it can 

 always be, at least temporarily, arrested. On no account should any one 

 who pretends to the character of a surgeon, employ inefficient means to stop 

 it, and imagine that he can, by covering up the wound with rags, handker- 

 chiefs, &c. , prevent the escape of blood. These procedures only hide the loss 

 that is going on, and, by increasing the warmth of the parts, prevent the 

 contraction of the vessels, and favour the contimiance of the bleeding. Under 

 all circumstances, therefore, bleeding wounds should be opened up, the 

 coagula gently removed from their surface by means of a piece of soft sponge, 

 or a stream of cold water and the part well cleaned. In this way you look 

 your enemy in the face and can adopt efficient means for the permanent arrest 

 of the haemorrhage " [Erichsen). 



2. REMOVE ALL DIRT, CLOTS OF BLOOD, AND OTHER 

 FOREIGN MATTERS.— We may do this by gently syringing the 

 part with recently boiled water which has been allowed to cool to 

 about blood-heat ; or, preferably, with a warm antiseptic solution, 

 such as 20 grains of chinosol, or half an ounce of creolin or carbolic 

 acid to a pint of water. A piece of antiseptic cotton wool, or a 

 clean cotton rag soaked in an antiseptic solution should be used 

 instead of a sponge, which is difficult to render thoroughly clean. 

 We should avoid touching the wound more than is absolutely neces- 

 sary. If the injury be superficial and the parts be not bruised, Ave 

 may allow the blood to remain on, so as to form a scab, in which 

 case, the process of healing will be greatly facilitated by dusting 

 the wound with tannoform. 



3. DESTROY ANY PUTREFACTIVE GERMS THAT MAY HAVE 

 GAINED ACCESS TO THE WOUND, by the application of an anti- 

 septic (p. 67). 



4. BRING THE EDGES OF THE WOUND TOGETHli^R.— It is 



best in most cases, to bring the divided surfaces together, as soon 

 as possible after the bleeding has ceased ; or if by bringing them to- 

 gether and applying pressure, we can stop the bleeding. We may, 

 however, have to leave the wound open for a few hours, especially 



