Scientific American Supplement, No. 299, September 24, 1881 · Chapter 32Simple Methods to Staunch Accidental Hemorrhage
This chapter is not translated yet. You are reading the original.
At first sight it seems almost superfluous to write or say a word about any method of arresting hemorrhage from wounds; for the practitioner, as a rule, is well acquainted with all the different manipulations and appliances for the purpose, and enough may be obtained from the text books. Nevertheless, to call attention to some useful, or old, or apparently forgotten matter occasionally, seems not to be amiss, for it refreshes our memory, stimulates us to think about and keeps before our eyes important subjects. A few hints on the above, I hope, will therefore be well received.
The treatment of hemorrhage, viz., the arresting of the same from open wounds, is not only important to the surgeon as the basis of surgery, but it is also of great importance to the laity, and especially to those workmen who are perpetually in danger of being injured. It is astonishing how unknowing the people seem to be, with any method to check bleeding from a wound temporarily; even the most simple method of pressure is in the majority of such accidents not resorted to. The sight of a little blood does not alone upset a timid, nervous woman, but many times the strongest of men; and why? because it naturally creates a feeling of awe and detestation. If a person is wounded by a machine, or otherwise, a crowd of all his fellow workmen gather around him, and look on the poor fellow bleeding; half a dozen or more will start out on a run in different directions to hunt a doctor, or some old woman who has a reputation for stopping bleeding by sympathy, either of whom they are likely to find "not at home." In the meantime the vital fluid trickles away; nobody knows what to do; everybody does something, but none the right thing. Now, it is true, it does not often happen that any one bleeds to death, wise mother nature, as a rule, coming to their assistance, especially in lacerated wounds; but the anemic condition produced by excessive loss of blood is followed by severe consequences, and is to be dreaded, for it retards recovery. To save all the blood possible ought to be apprehended as an important matter by every one.
Hardly a week passes that some unfortunate is not brought to my office, who has been badly injured in some way; he has been bleeding, perhaps, the distance of several blocks, and arrives almost faint. In the most of such cases they have something tied around their wounds, but hardly ever in any manner so as to be equal to stop the bleeding. In exceptional cases you find a tourniquet or the Spanish windlass applied. This, when applied by a surgeon, may answer very well, but when applied by a non-professional person it is invariably screwed up so tight that the pain produced thereby is so great and intolerable that the patient prefers rather to bleed to death. This is a great objection.
Therefore I will call attention to the method of forcible flexion; and though extreme flexion has been practiced by surgeons in isolated cases, still to Professor Adelman, of Dorpat, is due the credit of first having systematized the following method:
Bring the elbows of the patient as near as possible together upon the back, and fasten them with a bandage. From this point let a doppelt bandage pass down to and over the perineum; separate the bandages again in front, let one end run over the left, the other over the right groin back again to the elbows (see Fig. 1)
Fig. 1.
"The illustrations will explain at a glance."
Acute flexion of the elbow, simple bending of the forearm upon the upper arm, will suffice. But if there is bleeding from the arteries near the joint of the hand or from any part of the hand, then the hand must also be brought into flexion, and secured by a bandage. (See Fig. 2.) The bandage must always be wrapped around the wound first.
Fig. 2.
It needs no other explanation, as Fig. 3 shows the mode of stopping the hemorrhage from that region temporarily.
Bleeding from the front part of the leg (Art. Tibialis Ant.), same as Fig. 3.
FIG. 3.
Bleeding from the posterior part of the leg (Art. Tibiailis Post, et Peronea) same as above, with the addition of a tampon or compress under the knee joint, or like Fig. 4.
Flexion of the leg upon the thigh, and flexion of the foot upon the front of the tibia.
Objections might also be raised to the above method on account of the pain which it may produce; but the flexion never needs to be so forced as to be unendurable to the patient; the position may be a little uncomfortable to a very sensitive person, that is all. Furthermore, it has been proven that a limb can be kept in a flexed position for several days, "nine by some authors," without any injury, and with a complete closure of the arteries. We do not expect, however, that this method of arresting hemorrhage will ever be adopted as "the" method in surgery, neither will it be necessary here to point out any cases where the practitioner can have and under certain circumstances be obliged to have to resort to this simple method. Military surgeons may also profit by it, for it is certainly a valuable and admirable mode, and so easily applied in cases of emergency by any one, if the unfortunate should be distant from surgical aid. I also believe that it would be advisable and certainly humane, to instruct the people in general, by popular lectures or through the press, the manner of stopping hemorrhage temporarily.
Fig. 4.
The simplest of all methods, however, to arrest hemorrhage is the rubber bandage. It has displaced in surgery the old tourniquet almost completely, which required a certain skill and anatomical knowledge to apply it; not necessarily so with the rubber bandage. Any one can apply it, for the amount of pressure needed to arrest the hemorrhage from a wound suggests itself. The rubber bandage produces but little pain; the patient is comparatively comfortable and out of immediate danger and anxiety; while in the meantime the proper attention can be secured.
I think it would be well if our health officers would direct their attention a little to the accidental hemorrhages, and if they do not possess the power, to refer the matter to the proper tribunal to enact a law that would compel all owners and corporations of factories, saw, planing, and rolling mills, and, in fact, every establishment where the laborers are constantly in danger of accidents, to keep on hand a certain number of strong rubber bandages, according to the number of men employed, and that at least several of the men, if not all in every establishment of that kind, be instructed in the application of the bandage. Steamboats and other vessels should carry a supply, and railroad companies should be obliged to furnish all watchmen along their respective roads with rubber bandages, and see that the men know how to use them in case an accident should occur. Every train that goes out should have some bandages on board in care of some employe, who knows how to handle them when needed. Many pounds of precious blood may thus be saved, and danger to life from this cause be averted.--Indiana Medical Reporter.