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A N

ACCOUNT

OF THE

TOPICAL APPLICATION

O F T H E

S P U N G E,

Inthe Stoppage of HEMORRHAGES.

[ Price One Shilling and Six Pence. ]

A N

ACCOUNT

O F T H E

TOPICAL APPLICATION

OF THE

S P U N G E,

In the Stoppage of HiEMORRHAGES.

Read before the R O Y A L SOCIETY,

February ii, and i8, 1762.

By CHARLES WHITE, F.R.S.

One of the Corporation of Surgeons in London, and
Surgeon to the Manchefter Infirmary.

LONDON:

Printed for W. Johnston, in Ludgate-Strcct.

MDCCLXII,

T O

David Middleton, Efq;

(Serjeant- Surgeon to his Majesty, Surgeon-General
to the Army, and Surgeon to St. George^s Hofpital)

Mafter to the Court of Examiners,

AND TO

The Reft of the Incorporated Society of
Surgeons in London.

Gentlemen,

AS I have the honour to be one of your
Company, I do not know to whom I
can fo properly addrefs the following flieets ;
Give me leave, therefore, to put them under
your proteftion j and believe me to be, with
all due refped:.

Your moft obedient

humble fervant,

London, C. WHITE,

Feb. 2 2, 1762.

£ I ]

A N

ACCOUNT

OF THE

TOPICAL APPLICATION

O F T H E

SPUN G E, Sec.

TH E ftoppage of fuch hemorrhages as
have been cccafioned by the princi-
pal operations of Surgery, has in all ages em-
ployed the attention of thofe who have
been concerned in the various branches of
medicine. Fungous fobftances were certain-
ly ufed by the ancients j bat they laboured
under thefe difadvantages, the circulation
of the blood w^as then unknown, and the ufc
of the tourniquet undifcovered. They had
recourfe to the aftual and potential cautery,
and fomc of them in amputations divided
B the

[2]

the * flefli with a red hot knife, in order to
fupprefs, or rather to prevent the efFufion of
blood.

Styptics, and aftrlngents of all kinds,
were alfo applied -, but the infufficiency of
thefe applications, added to the cruelty of
fome of them, and the bad ftate in which
the flumps were frequently left by lofs of
fubftance, made all other methods give way
to the ligature, either with, or without the
needle. We are indebted to Ambrofe
Parcy for this difcovery. — At firft he
thoughthimfelf divinely infpired, and freely
communicated his invention ^ but, being vi-
rulently attacked by his cotemporaries, he
attempted to prove in his defence, that his
method had been in pradiceamongft the an-
cients, and in vain endeavoured to take away
from himfelf the reputation to which he
was fo juftly intitled. His improvement
was however eftabli(hed, and for more than
half a century was looked upon, in every
part of Europe where Surgery was cultiva-
ted, as the moft fucccfsful way to flop the

* Vefalius Chirurg. Magn. lib. v. Cap. 12. page 1082.

eruption

[31
eruption of blood in divifions of the larger
arteries.

This method has indeed fince his time
received fome few alterations, particularly
that of fubftituting the crooked needle
for a ftraight one. For tho' Parey ufed
a crooked needle in the fewing of deep
wounds, yet he always made ufe of a ftraight
one in applying the ligature to the veffels,
in fuch cafes as rendered the arterial forceps
inejflfedual.

Great inconveniences have notwithftand-
ing attended this method : in amputation it
is allowed, from the tefl:imony of many who
have undergone the operation, to be the moft
painful part of it, and " * it fometimes hap-
" pens in a large ftump,that ten or more vef-
" fels require tying." Convulfive fymptoms,
the locked jaw, and even death -f- itfelf,
have been its followers. It has alfo fre-
quently been found infufficient, either
when the parts have been lacerated and
contufed, or when the extremities of the
veffels have been fituated beyond the reach

* Sharp*s Surgery, p. 218. Ed. 8.

t Warner's cafes in Surgery, Ed, 3. p. 350.

B 2 of

[4]

of the needle i or again,when a freih effufioti
of blood has happened many days after the
operation, a plentiful fuppuration having
come on, and the parts being reduced to fuch
a fituation as not to bear a repetition of the
needle. A cafe of this lafl: nature happened
to the Marquis of Rothehn * after the
amputation of his thigh, and gave rife to a
very ingenious contrivance of M. Petit,
His inftrument, v^hich was fixed upon the
end of the flumps, made a conftant com-
preffion upon the veffel, faved the Mar-
iquis's life, and gained the greateft honour to
the inventor.

There have been alfo machines invented
by M. Sottere f and M. Belloque, for the
ftoppage of blood by compreffion, after the
divifions of the intercoflal arteries ; and
by M. Foucou + for the fupprefiion of vio-
lent haemorrhages, occafioned by extradions
of the teeth.

Pyramidal comprefles have been fre-
quently ufed with fuccefs, and are certainly

• Mem. Acad de Sciences, Pan 173 1. p. 123.

f Mem. de I'Academie Royal de Chirurgie, torn. if.

J lb. torn iii. p. 27.

fuf-

[5]

fafficient to anfwcr their defigns in wounds
Qf the head and many other places, where
the tightnefs of the bandage is not liable to
do an injury to the neighbouring parts.
But though perhaps there are not many
arteries in which a ftoppage may not be ef-
fedtcd by compreffion when applied with a
due degree of care and judgment, and that
too without the inconveniences which at-
tend the other methods ; yet the nicety |
which is required to determine the exadt
degree ; the danger * of making too tight
the circular . bandage in amputations ;
the length of time often required for
the continuance of the compreffion, the
difficulty of getting at the wound without
tightening the tourniquet upon every dref-
fing, and the hazard to which the patient
is expofed from the poffibility of the
comprefles being removed by any trivial
accident, are fuch objedions as have hitherto
prevented this praftice from coming into
general ufe.

The difadvantages attending thefe feveral
modes of operation, made it the general

* Medical Effays,Edin, yol, iv. Art, 22. p. 270.

wifh^

[ 6 ]

wifli, that fome more eafy^ fafe and certain
method might be difcovered ; when the
hopes of the public were raifed by M.
Broffard, who received a very confiderablc
reward from his mod Chriftian Majcfty for
his introdudlion of the agaric of the oak in-
to pradice. The moft fanguine wiflies
feemed now to be gratified, and the difco-
very was embraced by moft Surgeons with
the greateft avidity.

However, mature experience and repeat-
ed obfervations have convinced us, that
agaric is in many cafes infufRcient ; and that
fome times where it feemed to have been
fucccfsful, that fuccefs was as mtich to be
attributed to the compreffion ufed, as to
the virtues of the plant itfelf. Befides, on
account of the little fecurity of retaining
it upon the mouths of the divided veffels,
it was very difagreeable to praftitioners to
depend upon it, without its being watched
with the greateft care and affiduity. Ano-
ther difficulty too arofe, which was that
of procuring at all times the proper agaric ;
for as Mr. Warner * has juftly remarked, the
* Cafes in Surgery, p. 356.

cak

i7]

oak produces two different kinds. The one
has the appearance of foft leather, with apile
upon it fomething like that of velvet : the
other is thick, rough, and hard; and there
is yet another fungous fubftance frequently
imported, and ufed for the agaric, which
appears to be the fame with that defcribed
by Bregnius under the title oifu?2gus coria-
cius quercinus Hcemaiodes, I have ufed all
thefe^ if I am not greatly miftaken, and ia
my opinion the laft mentioned fubftance is
much to be preferred to the agaric itfelf.

The lycoperdon and fungus vinofus have
been alfo applied ; but all thefe applications
arc now difcarded in divifions of the lar-
ger arteries, and Surgeons find themfelves
again obliged to have recourfe to the
needle and ligature, notwithflanding its in-
conveniences.

There is how^ever another remedy,which
I think a duty incumbent upon me to lay
before the public ; one which as, far as I have
obferved, is not liable to any of the objec-
tions above recited, which is perfedly fafe
and eafy in its application, and in its effefts
more certain than even the ligature itfelf.

This

[8]

This remedy is nothing more than the lii-
fide of frefh and thoroughly dried fpunge.

I would not here be underftood to mean^
that I arrogate to myfelf the merit of being
thefirft, by whom fpunge has been apphed in
the ftoppage of hemorrhages. I am fenfible
that I am not. Spunge was in ufe amongft
the ancients, and they feldom if ever applied
it medicinally upon any other occafions*
We are told by Diofcorides, that new fpunge
conglutinates wounds and fiftulous ulcers,
and flops the efFufion of blood. The afhes
of burnt fpunge were alfo ufed externally.

Galen recommends them as powerful
rcftringents, and tells us, that one of his
mafters often applied, and always carried
fpunge about him, which as occafion ferved
he burnt with pitch, and frequently ufed hot
as a cautery or cauftic to flop haemorrhages
after his operations in furgery.

Amongft the moderns. Dale*, in his
Pharmacologia, fays, that fpunges are feldom
if ever ufed internally, but frequently by Sur-
geons to flop bleedings.

* Page 36.

Millar

f 9]

Miller"^, in his Bot. Offic. tells us, that they
are ufed by Surgeons in embrocations, and to
flop bleedings- and I muft not omit what
Mr. Reid of Chelfea has reported to the
Royal Society, that Mr. Chefelden, after an
operation for the ftone in the year 174 1-2,
put into the wound, which bled too freely,
a thin piece of wet fpunge for it to bleed
through, and that, contrary to his expefta-
tions, it prevented a further lofs of blood.
To thefe let me add, that Mr. f Morand

nightly

t " At the clofe of the year 175 1, an experiment
" was made oh dogs with the agaric of oak, which hid
<* already ferved for the fame purpofe, after having waih-
*' ed and dried it afrefh, aifo with the agaric of beech, of
*' birch, of the powder of lycoperdon, fuilainedby fome
" pieces of its fpungy part, with thefe fame pieces alone,
«« with the common touchwood, with little pieces of
" fimple fpunge very fine. The refult of all thefe trials
'* was, that the agaric of oak which had already been ufed,
^* did not fucceed fo well as the frefti agaric ; that the other
** agarics, the powder as well as the fpungy part of the
'* lycoperdon and the common touchwood, had all pretty
•* nearly the fame eiFe£l ; though thefe different prepara-
** tions not being fecuredby compr^ffion, all failed; that
*« the common fpunge appeared at firft to produce the
•* fame effect, but fell off with the reft. The detail of
** thefe experiments is to be found in a periodical work
C '' pqjit^i

[ ,o ]

flightly mentions fome experiments made
with fpunges and other fungous fubftances
upon dogs. I cannot however any where
difcover, that fpunge alone was ever ufed
after the divifions of the larger arteries in
the manner I do.

Boerhaave enumerates fcventeen forts of
Ipunges: The fpunge which I ufeis clofe,
compact, and flightly porous ; it generally
goes by the name of the male or line
fpunge. Iffl am notmiftaken, he has dif-
tinguiilied it in his Indt Att. Plant.* by the
title of fpongiay ad ufum prajianti/jima^ fo-^
raminibus exiguis pervia^ Tcurn, ^y^. The
beft come from the Archipelago.

The fpunge requires no other prepara-
tion than that of its being carefully dried,
I This for large arteries is abfolutely necef-
fary, efpecially in damp weather, fcarce any
fubftance imbibing a greater quantity of

«* printed at Paris, and entitled Journal CEconomique. See
«« the months of April and June 1752." But the author
is not there named. Mem. of the Royal academy of Surg.
Eng. Ed. by Neak, vol. ii. p. 186.
* Page 8.

moifturc

[ ri I

moifture from the air; as is evident ^f
when it is applied to the purpofe of an
hygrometer. Care ought however to be
taken, that it be placed at fo great a diftance
from the fire, when it is fet to dry, as to
prevent its crifping : and it ought afterwards
to be kept in as dry a place as poffible. I
have ufed the outiide of undried fpunges
upon fmall arteries with fuccefs ; in thefe
cafes it may do full as well, as it may be
taken off the wound more eafily : but then
it is necefTary to obferve, that, in proportion
as you leflen its adhefive quality, you di-
minifh its power upon the veffels. It is
this property, which gives it fo much
merit : from hence arifes its fuperiority to
the agraic. It is the texture of its parts,
and not any ftyptic or aftringent virtue,
from whence it derives its value.

f " A pound of fpunge, when weighed in a humid fea-
^* fon, on drying carefully in a ilove without injuring its
" texture, will be reduced to eleven ounces.'* Chanu
Suppl. art. Spunge.

I bought thirty-two fpunges, which to all appear-
ance were perfeftly dry. When they were brought
liome they weighed eight ounces, but upon their being
laid a few hours before the fire, they were reduced to th«
weight of fix ounces.

C 3 The

[ 12 ]

The part which nature takes In the. ftop-
page of blood, has been imagined by M.
Petit and his followers, to be by a coagulum
or clot of blood formed in the extremity of
the artery, extending itfelf four, five or fix
inches up it, in the refemblance of a cone,
with its bafe towards the part where the
divifions was made. Petit has * delineated
the figure of one of thefe little clots, from
an artery which he opened after death ^ but
it is moft probable that the coagulum was
only formed at that time, his hypothefes be-
ing liable to many objedions*f*. M.Pouteau
has offered a much more probable conjec-
ture; his opinion is, that the fwelling of the
cellular membrane, which furrounds the
artery, brings the fides of the veflfel into
contadt, and by that means prevents the
blood from efcaping. He opened feveral
arteries in which no coagula were found,
and where they were difcovered, they ap-
peared only to have been formed like po-
lypuflfes at, or after death.

* Mem. Acad, de Sciences I'an. 173 1.

f Melanges de Chirurgie, aLycmi 17^0, p. 314.

Thx$

[ 13 ]
This fwclling of the cellular membrane
is alfo mentioned by Dr. Monro * in his
Remarks on Amputations.

CASE I,

An Account of the good EffeBs of the Spunge^
where the Needle and Ligature could not
be made ufe off, and other Applications
were found ineffeBuaL

MR. Afhton, of Caftleton in Der-
byfliire, a ftrong healthful man,
about thirty years of age, came over to
Manchefter, to confult me about a fcirrhous
tumor, that had been for fome years grow-
ing under the maxilla inferior upon the
right fide, and in which he had lately per-
ceived 'fome darting pains, which, toge-
ther with the increafe of the tumor, had
fome what alarmed him. I advifed him
to have it diffeded out ; he confented

* " For as foon (fays he) as the ligature is made, the
«* cellular fubftance beyond the ftitch, having ilill a
** communication with the. furrounding cells, fwells and
" turns^ harder and firmer, fo as to prevent the thread
" from^fiidihg."

to

[14]
to the operation, and I performed it, in the
beginning of Odober 1760, in the pre-
fence of two young gentlemen n:iy pupils.
After cutting through the integuments, I
drew out the tumor with my differing
hook, and extirpated it.

In performing this, there was a very con-
fiderable branch of the external carotid ar-
tery opened. It was fituated fo far under
the maxilla in the bottom of the cavity,
where the tumor had lain, that I found it
impoffible to turn the crooked needle in the
wound. I enlarged the incifion with my
knife, and made a fecond attempt to take
up the veffel with no better fuccefs. I in-
effedually applied lint dipped in flower, fe-
vera! kind of flyptics, agaric of the oak, and
ftrong compreffion. But I muft remark,
that it was that kind of agaric which is
thick, rough and hard, my ftock of the
other being quite exhaufted. Noneofthefe
applications fucceeding, I was put upon the
difcovery of a proper fubftitute for the foft
agaric ; and dry fpunge, appearing to me
to have the greateft refemblance, I ftufFed
the wound quite full of it. I held it faft

for

[ '5 1

for a few minutes with my fingers -, after
fome time the dreffings were laid on, and
a comprefs was applied with a tightifti
bandage. Not one drop of blood iffued
out from the wound after the application of
the fpunge: on the fourth, and every fuc-
ceeding day, I renewed the dreffing, letting
the fpunge remain, as I found it v/ould not
come off without fome little violence, till
the loth, when I removed it, and at the
fame time made an obfervation, which ex-
plained to me the manner of its acting in
the ftoppage of blood. I obferved that it
adhered intimately to the cellular mem-
brane, and flefliy fibres, with which it was
fo much interwoven, as almofl to have the
. appearance of one body. This rendered it
impoffible that the leaft drop of blood fhould
efcape; and the reafon of it appeared evi-
dent. The fpunge being perfedlly dry
• when applied to the wound, and kept on
by a moderately tight bandage, introduces
itfelf by its foftnefs and elafticity between
the fibres of the flefli and cellular membrane,
which are themfelves infinuated into the
porous- parts of the fpunge. The fpunge

thus

[16 ]

thus receiving and being received, is expand-
ed by the moifture of the part, whence it
becomes wedged fo faft, as not to be torn
away without force. The cohefion every
moment grows more flrong, till the fpunge
is fully expanded, and caufes fuch a compref-
lion upon the fides of the veffel, as to bring
them into contact, and render the efcape
of the blood impoflible. If the torrent of
blood therefore can but be reftrained till
thefe efFeds are produced, either by pref-
fure upon the fpunge, or by the ufe of the
tourniquet, where that can be properly ap-
plied, there v/ill be no danger of an hae-
morrhage even after the divifions of the
largeft arteries ; and fhould the bandage
and dreffings by any accident be diiplaced,
the fpunge will in a litde time be found to
have fecured its own fituation. I muft
here obferve, that though the wound was
quite filled with fpunge, and though it re-
remained ten days in that fituation, I
never faw one in a better condition than
this was in at the expiration of that time. Ic
was as thoroughly digefted as if the mod
powerful digeftives had been made ufe of.

The

The fpunge was fully fatiirated with the
matter. The wound, though a deep one,
in about a month was filled up with new
flefli, and perfed:Iy healed, by which I was
fatisfied that its cure was not in the leaft
impeded by the application.

It was not long before I had repeated op-
portunities of obferving the effeits of the
fpunge in haemorrhages proceeding from the
fmaller arteries, occafioned by the opening of
abcefles, by accidental wounds in different
parts of the body, by the extirpations of
tumors of various forts, and by the exci-
£on of fcirrhufes and cancers in the breaft.
I likewife applied it to the lefTer veffels af-
ter feveral amputations of the larger extre-
mities, taking up however with the needle
one or two of the principal arteries. For
as the character of this remedy was not
yet fufRciently cflabliflied, I was careful
how I proceeded, and therefore never ven-
tured it alone, after the principal amputa-
tions, till the loth of Auguft 1761, when
after taking off a leg it perfectly fucceeded,

D CASE

[ i8 ]

CASE III.

jin Account of the fiiccefsfid Application of
the Spunge^ on the 2otb Day after Am-
putation^ in a Cafe where the Needle and
Ligature had been made ife offy and proved,
infuficient.

"^HoQias Taylor, of Billinge, near
Wigan, in this county, aged 50^
v/as admitted into the Manchefter Infir-
inary on the j 2th of January 1761, for
fome bad ulcers in his right-hand, which
were attended with a caries of moiil of the
carpal bones, and of the inferior extremities
of the ulna and radius. Thefe complaints
had been of many years (landing, and the
abforption of the matter had brought on
heftic heats, a bad cough, and noctur-
nal fweats. Under thefe prefiing circum-
flances, it was thought neceflary, at a con-
fultation, to take off his hand in order to
preferve his life. On the 1 5th of the fame
month, I performed the operation a little
above its articulation v/ith the radius and

ulna.

[ 19 ]
ulna. After taking up the arteries with the
needle and ligature, the flump was dreffed
with dry iint and flour, covered with
pledgits fpread with yellow bafilicon, and
fecured upon the part by a proper ban-
dage. Nothing remarkable happened till
the 14th day, when a fudden and profufe
hemorrhage came on from the cubital ar-
tery, which was immediately taken up by
a pupil in the houfe, but barft out again
the next day, and was again fecured by the
needle and ligature. The day after that,
upon another eruption, the agaric of the
oak, Roman vitriol, and alum, were fepa-
rately applied, ftrong compreffion was made
ufe of, and the bark was given in great
quantities. Not one of thefe had the de-
fired efFed. He ftill continued to bleed in
a greater or lefs degree till the morning of
the 20th day after the operation • when he
had loil fo much blood (notwithftanding
the greateft care had been taken to re-
ftrain it, as often as it appeared, by the
tourniquet, which from frequent ufe was
obliged to be fixed in different places to
prevent its galling) that what came from
D 2 I him

[20]

him was fo thin, as fcarcely to retain either
colour or confiftence, and the linen he
made ufe of, was, when dry, but juft tin-
ged here and there with red. In thefe de-
plorable circumflances I applied the fpunge,
and over it the ufual dreffing ^ but as all
the parts contiguous were in a ragged rot-
ten fituation, as well from the frequent re-
petition of the needle, as from the bad con-
dition of his body, I judged it neceflary to
make a ftronger compreffion than ufual on
the part. I therefore applied a fcrew in-
ftrument, fomething fimilar to that which
M. Petit contrived for the Marquis of
Rothelin, to the end of the flump, over the
dreffing and bandage.

In the afternoon I was again fent for, and
found him bleeding very fall: : he had fain-
ted away, and had fo much the appearance
of a corpfe, that I thought he would have
expired immediately. Upon uncovering
the wound, I perceived that the inftrument
had been of great differvice, not having a
fufficient fufface to aft upon. This was
occafioned by the pointednefs of the flump,
which had been reduced by the repeated

ufe

[21]

ufe of the needle and other applications. I
was not however without hopes of faccefs,
if I could keep my patient alive a little
longer. A frefh piece of dry fpungc was
placed over the mouth of the veflel, and
upon that a quantity of lint to increafe the
furface. I retained thefe faft by four crofs
flips of good flicking plaifter, and thefe
again were fecured by a roller. To make
a compreffion upon the end of the flump, I
fixed the fcrew inflrument oyer all, with its
flraps brought up above the elbow, and
there faftened as well as poffible by a ban-
dage, obferving at the fame time to keep
the arm bent ; and I continued for fome
minutes Freke's tourniquet tight upon the
upper part of the humerus. A few hours
afterwards I flackened the fcrew upon the
end of the flump, the bleeding had entire-
ly ceafed, and never afterwards returned.
At the end of three days I removed the
drefiings, and found that the fpunge had fo
far fecured itfelf in its fituation, as not to
be removed without confiderable violence.
Fearing a renewal of the haemorrhage, I
fuffered it to remain between five and fix

weeks

[ 22 ]

weeks upon the wound : In which time
granulations of flefti had fhot up into the
pores of the fpunge 3 and the difficulty
of its removal was fo great, that I was
obliged to feparate but a fmall portion of it
every day, which I cut away with my fcif-
fars, till the whole was extirpated. The
difficulty I here met with, has ever fince
obliged me to guard againft this inconve-
nience, by removing the fpunge after it has
remained ten, twelve, or fourteen days upon
the wound -, and if I have any apprehen-
lion of a new eruption, I apply frefii
fpunge, which I find much better than the
continuance of the firft application.

• Perhaps it may be faid, that the com-
preffion I made ufe of would alone have
flopped the bsemorrhage. — Very poffibly it
might ', but then the compreffion muft have
been continued for feveral we^k?, which by
the affiftance of the fpunge was rendered
totally unnecefiary.

CASE

[ -~3 ]

CASE IV.

An Account of the Application of the Spiinge
with Succefs^ after an accidental Wound
in the Leg,

AS Orlando Hague, of Afhton Under-
line, aged 48, was getting peat up-
on the 8th of June 1761, he had the mif-
fortune to ftrike his turf-fpade into the in-
fide of his leg, about the middle of it, and
open the artery called tibialis poflica. A
torrent of blood inftantly fucceeding,
he had the prefence of mind to lie his
handkerchief very tight about his leg,
which probably faved his life, as by that
means he reftraintd the hsemorrhage a little,
though he could not fiop it entirelve His
friends immediately brought him to Man-
chefter, which is five or fix miles from the
place where he received the hurt, he con-
tinuing to bleed all the way.

I fixed thetourniquet above his knee; and,
after I had fufficiently cleanfed the wound
from grumous blood, applied dry fpunge,

and

[24]

and over that the ufual dreffings, retained by
a moderately tight roller. I then loofened
the tourniquet; and though he wasdircd:ly
carried up to the Infirmary, which is a
quarter of a mile diftant from the houfe
where I applied the fpunge, not the leaft
effufion of blood fucceeded.

The fpunge was removed in about a
week after the accident ; he remained in the
Infirmary till the 22d of the fame month,
when, after being made an out-parient, he
returned home, and on the 27th of July
was difcharged, perfeftly cured.

CASE V.

An Account of an Amputation of the Leg
below the Knee^ where the Spiinge was ap-
plied with Succefs.

William Slater, of Knott Lanes, in
the parifli of Afhton, aged 24,
of a very fcrophulous habit of body, had
for fome years been troubled with white
fwellings in his ancle, which at laft gather-
ed and broke. The inferior extremities of

the

[25 3

the tibia and fibula, and fome of the
tarfal bones being carious; Upon the ad-
miffion of the air, his pain increafed
greatly, and the abforption of the mat-
ter brought on hedical fymptoms, a bad
cough, and colliquative fweats. Amputa-
tion was the only chance to fave his life,
and I performed the operation on the
loth of Auguft 1 761, in the prefence of
one of my pupils, and of feveral other
perfons. After fawing through the bones,
the tourniquet being flackqned, the ar-
teries tibialis antica, poflica, and peronea,
bled very freely. I again tightened the
tourniquet, wiped the flump with a fpunge
preffed out of warm water, and deanfed it
from grumous blood. Three pieces of dry
fpunge were now applied to the extre-
mities of the veffels, over them the com-
mon dreffings, and thefe were retained by
a roller, put on rio tighter than juft to keep
the fpunge in contad: with the ends of the
arteries.— He w-as put to bed, and the tour-
niquet kept tight for fifteen minutes, after
which 1 flackened it entirely, and had no
further occafion to repeat its ufe. He was
E remark-

[ 26 3

remarkably eafy after the operation, much
more fo than I had ever obferved any pa-
tient after the ufe of the needle and liga-
ture. He flept well all night without the
affiftance of any opiate, and no fymptomatic
fever enfued. Upon the fourth day I re-
moved the dreffings, and found that the
fpunge adhered very clofely. The wound
was drefTed every day, and at every dreffing
a little lint put under the fides of the
fpunges, to make them feparate more eafily.
On the 3 0th day I removed one piece of
fpunge, and on the i2th the other two, en-
tire, with the greateft facility, and without
the leaft hemorrhage enfuing. The ftump
looked remarkably well, was as thoroughly
digefted where the pieces of fpunge had
lain, as if the moft powerful digeilivcs had
been applied, and continued to mend v;ith-
out interruption. However, his other fymp-
toms grev/ daily worfe, he was quite tired
cut with taking medicines, and evidently
appeared to be in the laft ftage of a con-
fumption. The ftump being now almoft en-
tirely healed, my longer attendance became
unneceflary. I therefore difcontinued my

vifits.

[27]

vifits about the latter end of Oflober, and
have been fince informed that he is dead.

CASE VI.

An Account oftheSuccefs of the Sptmge after
the lateral Operation for the Sto7ie,

CD. aged 69, having been troubled
^ with the ftone in his bladder for fome
years, came over to Manchefter in Auguft
laft, in order to be cut. I performed the
operation on the 27th of the fame month,
in the prefence of Dr. Nathan Alcock, Fel-
low of the Royal Society, and of the col-
lege of Phyficians, of my father Dr. Thomas
White, Licentiate of the college of Phvfi-
ciansin London, and member of the Royal
Academy of Surgery at Paris, and of feveral
other gentlemen, when a large ftone was
extradled. My patient ftruggled much ;
which, added to the heat of the weather,
made him bleed very freely from an artery
upon the proftate gland. I tried the effe.'t of
lint dipped in vitriol water ; but that not fuc-
ceeding, I introduced a piece of dry fpunge,
E 2 to

[28]

to which I had tied a thread, In order to ex-
tract it whenever it (hould be found necef-
fary. This flopped the bleeding. In about
two hours the urine ran out of the wound,
(through the fpunge) perhaps with lefs
difficulty than if no fpunge had been
made ufe off; for it fometimes happens,
that the water does not make its exit fo
freely as could be wifhed. In a few days
I began to feparate the fpunge from the
fides of the wound with my fingers. Upon
the 8th day I introduced an hollow cane,
whofe diameter was about tv^^o-thirds of an
inch, and by the help of the thread drew
the end of the fpunge into it ; then thrufting
the cane gently forward with one hand, and
drawing the thread with the other, I pulled
it more and more till the whole was fepa-
ratedj not the leafl haemorrhage enfued, and
he returned home cured in about nine
weeks after the operation.

CASE

[29 3

CASE VII.

An Account of the fuccefsful life of the
Spunge after an Amputation of the Hand,

J Ames Berry, of Worfley, in this county,
aged 20, a ftrong healthful man, of a
fanguine conftitution, had the misfortune to
have his hand greatly fhattered by the fall
of a ftone, as he was working at the canal
belonging to his Grace the Duke of Bridge-
water. The accident happened about nine
o'clock in the morning of the 5th of Sep-
tember 3761, and he was brought to the
Infirmary that day about noon. He com-
plained of great pain, which extended itfelf
up into his fhoulder 3 he was very hot, and
his pulfe full and quick. At a confultation,
amputation was thought neceflary, and I
took off the hand at its articulation with the
radius and ulna about twx) o'clock in the
afternoon, in the prefence of Mr. James
Burchall and Mr. Edward Hall, Surgeons to
the Infirmary, of Mr. Nathaniel Poole the
Apothecary, and of feveral other gentle-
men.

[ 30 j
inene Upon my flackening the tourniquet,
the radical and cubital arteries fpouted out ;
I tightened it again for about fifteen mi-
nutes v/hilfl: I applied the fpunge, and ufual
dreffings, and fecured them by a roller,
when it was entirely loofened without the
leaft ejfrufion of blood fucceeding. The
heat and pain in his arm llill continuing, I
ordered him about feven o'clock in the
evening to lofe fiixteen ounces of blood, and
to take an opiate ; which, together with
nitre, and a little opening phyfic, in a few
days removed thefe fymptoms. One of
the fpunges was taken away without any
difficulty upon the feventh, and the other
upon the ninth day after the operation.
The wound had a very good appearance, was
thoroughly digefted, and every thing went
on extremely well till the i6th day, when
he began to perceive a little forenefs in his
throat, a ftifFnefs in his lovi^er jaw, and a
pain in his fore-arm. Thefe complaints,
which he attributed to a cold, were fo very
trifling, that he did not acquaint any perfon
with them till the 19th after the accident,
when it plainly appeared that he was affec-
ted

[3i]
ted by that terrible fymptom of a diforder
called a locked jaw. As this fymptom could-
not poffibly be occafioned by the fpunge,
the particulars are foreign to my intention ;
it is fufficient to obferve, that, after many
medicines had been tried, particularly opi-
ates rn great quantities,, both externally and
internally, without the lead fign of am.end-
mentj he w^as perfecflly cured by frequent
repetitions of warm bathing, which was
agreed to at a confiiltation upon my pro-
pofal. I was induced to try this remedy by
the good efFefe which I had formerly ex-
perienced from it at the clofe of a diforder
of the fame nature, an account of which the
gentlemen of the Medical b'ociety in Lon-
don have done me the honour to publifli,
in the fecond volume of their Obfervations
and Inquiries. In which cafe, however,
the warm bath was only made ufeof, to re-
move that ftifFnefs and univerfal rigidity
which remained after the removal of the
diforder ^ but in this it was evident that the
locked jaw, and other fpafmodic and con-
vulfive fymptoms, were abfolutely removed
by the help of the bath alone. He was

dif-

[ 32 ]

difcharged on the 7th of December with a
good ftump, and without the leaft difagree-
able fymptom remaining.

CASE VIIL

An Account of the fuccefsful Application of
the Spunge, after an Amputation of the
Fore-Arm.

ALice Horradge, of Harwood, aged 44,
had been for fome years troubled
with ulcers in the fore-arm, attended with
a caries of the carpal bones, and of the
lower extremities of the radius and ulna.
After having been unfuccefsfuUy treated by
feveral perfons, fhe came into the Infir-
mary, in order to have her arm taken off;
and I performed the operation in the mid-
dle of the fore-arm on the 2d of November
1 76 1, in the prefence of Dr. Peter Main-
wearing, Dr. Samuel Kay, and of Dr. Philip
Brown, Phylicians to the Infirmary, of Dr.
John Lloyd, F. R. S. and of feveral young
gentlemen. Upon loofening the tourni-
quet, the radial and cubital arteries, to-
gether

[33 ]

gether with the fmallcr branches bled {icQ"
]y. I tightened it again, and dried the
flump with a fpunge prefTed oat of warm
water. I applied pieces of frefh dry fpunge
to the extremities of the veiTels, and over
them the ulual dreffings, retained by a
linen roller, fome turns of which w^ere
brought above the elbow of the tightnefs
ufual after amputations. At the expiration
of a quarter of an hour the tourniquet was
flackened, without any efFufion of blood.
She was remarkably eafy after the operation,
and no fymptomatic fever enfued. Upon
the 8th day I rem.oved the fpunge which
lay upon the cubital artery. This occafi-
oned the velTel to bleed again, but with a
very fmall contrafted ftream. I ftopped
this eruption with my thumb, till a frefli
piece of fpunge could be got ready, upon
the application of which the hemorrhage
inftantly ceafed, without m,y being obliged
to have any recourfe to the tourniquet. Up-
on the loth I took away the other fpunge
without any inconvenience, and I removed
that which w^as laft applied upon the 14th,
w^ithout the leaf!: effufion of blood. The

F wound

[34]
wound was as fine and frefh as poffible, it
continued to mend without interruption,
except in one fmall fpot, where a piece of
fpunge about the bignefs of a pin's head
had been left -, this I exped:ed would have
digefted away of itfelf, but finding it
would not, I touched it with fpiiit. vi-
triol, fort, which entirely took it av^ay.
She was difcharged cured, January 25,
1762.

CASE IX.

An Account of an Operation for the radical
Cure of the Hydrocele^ in which the Spunge
was fuccejsfully applied.

Robert Fletcher, of Little Levir, in
this county, aged 47, was admitted
into the Manchefter Infirmary, and fell un-
der my care. He had on the right-fide an
hydrocele of the tunica vaginalis teftis, and
on the left not only an hydrocele of the
fame tunic, but alfo of the tunica vaginalis
of the fpermatic cord, which extended up
above the rings of the abdominal mufcles.
■ , The

[35]
The feptum between the two hydroceles of
the left-fide was broke, and the unfortunate
patient laboured under more pain on that
fide, than I ever knew to proceed from this
diforder. I pundlured both fides with my
lancet, and let off the water y but in a
few weeks they were filled again, and his
pain returned. As he was prevented fol-
lowing his bufinefs, which was the only
maintenance of his family, and was con-
tinually in torture, he was defirous oi un-
dergoing any thing that might free him
froni his diforder, and I confented to the
operations on both fides, for the radical cure,
on the ift of December 1761. Thefe I
performed nearly afrer Mr. Douglas's me-
thod by the excifion of the cyfts, but with-
out removing any of the lldn, as he had not
any to fpare. He bore thefe painful opera-
tions with the greateft fortitude and pati-
ence. There was no haemorrhage of con-
fequent:e, except from the fcrotal artery
upon his right-fide. To this I applied a
piece of dry fpunge, and held it on with
my fingers about a minute, which perfediy
flopped the bleeding ; over the fpunge I
F z placed

[ 36 ] .
placed the common dreffings, and retained
them on 'by a bag«trufs. At thefe opera-
tions were prefent Dr. Kay, and ieveral
young gentlemen. My patient told me in
the afternoon, that he had more eafe than
he had for fome weeks felt. He refled
•pretty well at night, without the affiftance
of any opiate, and very little of a fympto-
matic fever enfued. On the 8th day I re-
moved the fpunge without any hsemor-
rhage. He continued to mend without in-
terruption, and was difcharged cured upon
the nth of January 1762.

CASE X.

In which the Spunge was applied with Sue-
cefs below the Knee after Amputation.

J Ames Oats, aged 1 5, was admitted in-
to the Infirmary, for ulcers in the ancle,
attended with a caries: Amputation was
refolved upon at a confultation, and I per-
formed the operation upon the ift of De-
cember 176 1, about noon, in the prefence
of Mr, Poole ths Apothecary, and of feve-

ral

[ 37 ]
ral young gentlemen, apprentices or pupils
to the Surgeons of the charity. After I had
taken off the lin:ib, I applied the fpunge to
the arteries, and kept the tourniquet tight
for about fifteen minutes, when I loofened
it without the enfual of any hemorrhage.
The patient was very reftlefs and'ungovern-
able, and about feven o'clock pulled up the
ftump, in which he had fome twitchings,
with fuch a jerk from the pillow as occali-
onedit to bleed. The tourniquet was im-
mediately applied, and I was fent for by an
afliftant whom I had left in the room. The
fpunge which I had made ufe of was un-
dried, juft as it came out of the Apotheca-
ry's {hop, neither was it of fo good a fort as
I could have wifhed, a great part of what
was in the houfe having been wet and
damaged in the carriage. For thefe reafons
I thought it proper to apply fome frefh
fpunge, which I had brought with me, and
upon which I could have a greater depen-
dance. The hemorrhage was from the
tibialis antica, and as the mouth of the vef-
fel had receded, I was appreheniive that
the interoiTeal ligament, along the fide of

which

[ 38 ]
which the artery runs, might from its rc-
fiftance prevent the fpunge's coming pro-
perly into contaft. I therefore cut into the
ligament about one third of an inch with
fciflars, and after ckanfing the flump from
blood, and drying it with a fpunge, I appli-
ed dry fpunge, not only to the extremities
of the vefTels, but even covered the greateft
part of the wound with it, in order to pre-
vent any trouble from the fmall capillary
vefiels. I loofened the tourniquet in about
a quarter of an hour, and gave my patient
an opiate in order to keep him quiet. He
did not bleed one drop after this, was per-
fectly eafy, and flept well all night. He
had no occafion for the repetition of the
opiate, and had litde or no fymptomatic
fever. I removed fome of the fpunges up-
on the loth day after the operation, but
did not take away the reft till the 14th,
when they all came off entire, except one
w^hich lay upon the tibialis poftica. This
as I was attempting to remove it, tore,
and part of it was left behind. The
accident was owing to the fpunge*s not
being cut tranfverfely, as it ought to have

been ^

[39 ]
been ; and as the other pieces were but
according to the lay, which cccafioned
the laft ftratum of the fpunge to be left be-
hind, I (hould have found fome difficulty
in removing this ilratum, if I had not hit
upon an expedient which eafily made it fe-
parate. This was by touching it with the
butter of antimony, which, tlio' a very
ftrong cauftic, occafioned little or no pain,
as there was not fo much ufed as would af-
feft the flump fo far as to make an efchar,
but only jufi: fuch a quantity as would ef-
fect my purpofe* I am confident this acci-
dent will never happen, if the fpunge be
cut properly, and be not of a ragged rotten
fort. But if, from any miftake, this fhould
ever be the cafe again, I would adyife the
application of either of butter of antimony
to the fpunge, or of that flrong fpirit of vi-
triolj which is improperly called oil of vi-
triol. For if any part of the fpunge fhould
remain, it would be productive of nearly
the fame, tho* perhaps of not quite fuch
bad confequences, as arife from the leaving
a ftitch behind. Granulations of the flefh
would be apt to flioot up and cover it, as

they

[40]
they fometimes do a flitch, and would pro-
bably retard the healing of the ftump. I
would not be underftood to mean that I
would touch ,the ftump itfelf with any po-
tent cauftic. I would only apply it to the
fpunge. For if a liquid cauftic be made
ufe of, it will run through its pores, and
thereby bring on a feparation. My patient
continued to mend without interruption, is
now ftrong and healthy, and his ftump near
healed.

C AS E XL

Of an Ampitation of the Brcafi^ where the
Spunge ivas applied with Euccefs.

AB. of Manchefter, aged 60, confult-
^ ed me upon account of a cancer
of a very quick growth, in her right breaft.
Though file had not had any complaints
for more than fix or feven months, it had
already begun to ulcerate, but was not ad-
herent. I advifed her to have the breaft
taken off, which ftie confented to, and I
performed the operation upon the 5th of
December 1761, about two o'clock in the

after-

[ 41 ]

i30bn, in the prefenceof three young gentle-*
men my pupils. The wound bled more
freely than ever I had feen one of the fame
nature, not only from a large artery, but
from its whole furface, which was far from
being fmalL I wiped it as dry as pbffiblei
after which I applied a piece of fpunge to
the mouth of the large veffel^ and lint and
flower to the rcflc of the wound j but it con-
tinued to bleed fo faftj that I was obligedi
to remove the lint^ and cover the whole
with fpunge : my fpunge was juft as it
came out of the fadler's {hop, and as it was
a wet day, had imbibed fo great a quantity
of moifture from the air, that I was afraid
it would not anfwer. Accordingly fom©
blood did ou2se through it. I therefore laid
fever^l pieces of fpunge before the fire^ to
dry, and as I was called away to another pa-
tient, left diredtions with Mr. Starkie, my
apprentice, to remove the fpunges which
had already been applied, provided the
wound fliould continue to bleed, and to apply
thofe which I had laid to dry. This he ac-
cordingly did abouthalf an hour after. The
haemorrhage inftandy ceafed^ and never af-
G terwarda

[ 4Z 1
tgrwards returned. From hence appears the
Beceffity of having the fpunges fufficiently
dried, the fame fpunge when moift pro-
ving infufficient. Five or fix pieces of
^unge were applied. They not only co-
vered the whole furface of the wound, but
even part of fome of them lay under its
lips. Her breaft was eafy after the operar
tion, and fhe had no fymptomatic fever*
By degrees I loofened the fpunges, and re-
moved them one by one, till the laft was
taken away upon tbe 14th day after the
amputation ; though the wound had been
wholly covered, I never faw one in a better
ftate, or more thoroughly digefted, and it
was perfedly healed in about fix weeks af-
ter the operation.

This cafe gave me more than ufual
trouble j but I had before made fuccefsful
ufc of the fpunge, after the amputation of a
lady's breaft from Blackrod, upon the 2yth
of Oftober 1760, without the occurrence
(©f any vexatious accidents

e A&E

[43 3

CASE XII.

jin Account of an Amputation above ths
Knee, after which the Spunge was applied
with Succef to the Crural Artery,

A Lice Watfon, of Manchefter, aged
12, was admitted in the Infirmary,
upon the 7th of December 1761. She had
been received as a patient about ten months
before, for a white fwelling in her knee.
I then advifed her to hav.e the limb taken
off; but upon her refufing to confent, Ihe
was removed by her friends. She was,
however, now brought with a great defire
of fubmitting to the operation, but was
much altered for the worfc. The burfal
ligament was fo confumed, that there was
aperfed diflocation of the joint. Several
finuous ulcers run up the thigh. The dif-
charge was, very great, heftic heats were
daily confuming her, and fhe v/as fo ema-
ciated as to be reduced to the greateft ex-
tremity. At a confutation of the Phyfici-
ans and Surgeons of the Infirmary, amputa-
G 2 - tion

[ 44 3
tion was agreed upon, as her only, though
but a wretched chance. I performed the
operation in the middle of the thigh, upon
the 1 6th of December 1761, in the pre-
fence of Dr. James Walker, late Phyfician
to the Infirmary, and of feveral other gen-
tlemen. Upon ilackening the tourniquet
the femoral artery bled freely. I tightened
the tourniquet again, and after drying the
ftump with a fpunge prefled out of warm
water, I applied a cubical piece of fpunge,
whofe diameter was about an inch, to the
mouth of the velTel ; and to prevent any col-
lateral branches from being troublefome, I
placed a whole undried fpunge over the
other, upon the furface of the flump, fe-
cured by four crofs flips of good flicking
plaifters. Thefe I put ®n not only to keep
the fpunges in contacfl, but alfo to prevent
the Ikin from receding too much. By de-
grees I flackened the tourniquet, and in lefs
than half an hour after the fpunges were
applied, I entirely loofened it. Upon the
8th day I took ofFthe crofs flips of plainer
^nd the upper fpunge, and upon the 12th
removed the fpunge which lay upon the

femoral

[ 45 }
femoral artery. No hasmorrhagc enfued,
and the wound was perfectly digefted. She
is conftantly attended by Dr. Brown, who
prefcribes fuch medicines as are mod likely
to recover her health, but, as the amputation
was deferred by much too long, with very
little profped of fuccefs. It . is now feven
weeks lince the operation was performed,
the patient is alive, and the (lump near
healed.

C A S E XIII.

An Account of an Amputation of the Great
Toe^ and part of the Foot, where the Spunge
ivas ufed with Succefs, without having
Recourfe to the Tourniquet,

MAry Shephard, of Rochdale, aged
20, an inn-patient of the Infirmary,
was troubled with a fpina ventofa of the in-
ferior extremity of the firft bone of the me-
tatarfus. On the i6th of January 1762,
I took off" the great toe, together with
the ineferior extremity of the metatar-
fal bone to which it is joined. An ar-
tery bled freely. A piece of dry fpungc

was

[46 3

applied, and over it the ufual drefling, retain-
ed by a roller juft tight enough to keep the
fpunge in contacS with the veflel. This
impfiediately flopped the haemorrhage, not-
withftanding the tourniquet was neither
ufed during the time of, nor after the ope-
ration. The fpunge was removed upon the
yth day without any hasmorrhage enfuing.

CASE XIV.

An Account of an Amputation of the Leg
below the Knee^ after which the Spunge
was applied with Succefs.

J Ames Perclval, of Manchefter, about
8 years of age, was brought to the In-i
firmary, in order to have his leg taken off,
for a caries in the ancle joint. I performed
the operation in the morning of the 26th of
January 1762, in the ufua! place below the
knee. Immediately after the amputation I
cut upwards into the intejroileous ligament
about ope third of an inch, I eafily dif-
cpyered the principal arteries v/ithout flac-
kening the tourniquet^ and applied pieces of

[ 47 1
dry fpunge to the mouths of the veflels,
over them a fmall whole fpunge undried,
retained by four crofs flips of good flicking
plaifter ; upon thefe I placed pledgits of
tow fpread with yellow bafilicon, and then
fecured the whole by the bandages com-
monly made ufe of in fuch cafes, put on
with the ufual degree of tightnefs. I
flackened the tourniquet in about eight or
ten minutes after the application of the
fpunge, without any hasmorrhage enfiiing.
The patient did not lofe a fpoonful of blood.
In about an hour hQ took a quarter of an
ounce of the fyrup of poppies, was perfcdl-
ly eafy, and flept moft of the afternoon.
Dr. Brown and feveral other gentlemen
were prefent. As he was a little reftlefs,
about midnight he took another quarter of
an ounce of the fyrup of poppies. After this
he reflcd perfectly well, was free from pain-
in the morning, and had fcarcely any fymp-
tomatic fever.

On the 5tb day I took off the crofs flips?
of flicking plaifter and the upper fpunge.
On the 8th I removed that fpunge which.
lay upon the peroneal artery,, and opoa

tho

[48 ]
the loth day after the operation I took
away the other two whole and entire, with-
out the leaft hasmorrhage enfuing.

The fpunge has never yet failed me^
though I have applied it within thefe fix-
teen months to upwards of fifty patients,
and have conftantly ufed it fines lafl: Mid-
fummer, without ever having had recourfe
to the needle and ligature, except in two
inftances. In thefe cafes I made ufe of the
ligature, not becaufe I thought the fpunge
was infufficient, but becaufe 1 apprehended
it would be more convenient. My patients
were two perfons afflided with the ftone,
a boy from Wakefield, whom I cut in
the Infirmary, upon the 7th of Odober
1761 ; the other a gentleman from Hali-
fax, who underwent the operation about
the middle of the fame month. In both
thefe cafes an artery was opened at the be-.
ginning of the operation, and it appearing
moft.prudential to fecure the veffel before I
introduced the gorget, I chofe this method
of doing it, as that which would be liable to
the few^d incoavenienccs.

From

[49]

From the obfervations which I have
Inade, I am at prefent of opinion, that if
the fpunge be ufed according to the rules
which I have laid down, and which I fhall
again recapitulate, it is preferable to any
other method, and will always prove fuc-
cefsful, except in fome few capital cafes>
where the tourniquet cannot be made ufe
of; as after the amputation of an arm at
the fcapula, an operation which fo feldom
occurs, as hardly to deferve the name of an
exception, but in which, whenever it does,
the needle and ligature will certainly deferve
the preference, as well as in fuch cafes in
lithotomy as are limilar to thofe above-men-
tioned • but on the arteries which lie upon
the prollate gland the fpunge will have the
advantage, as thofe veflels cannot eafily be
come at by the needle:

I fhall not be afhamed to retradl anr
thing I have advanced, if I fhall hereafter
find that I have been too fanguine in my
expedations. But I thought it better to
publifh the few cafes which have already
prefented themfelves, than to wait for more,
as by this means other proficients will be
H more

[ 50 ]
more eafily induced to make trial of the
fpunge, and, I firmly believe, to eftablifli its
reputation. It has already been fuccefsful-
ly applied by feveral Surgeons in fmallcr
cafes upon my recommendation. But I
have not yet heard that it has been entirely
relied upon by any perfon, except myfelf,
after amputations of the larger extremities,
cr in any of the capital operations. 1 have
not applied any ftrong compreffions to the
ends of the ftumps after any of the amputa-
tionsj where the fpunge has been made ufe
of, except in the cafe of Thomas Taylor,
upon whom, as the reader will remember^
the needle and ligature proved ineffedual.
It has not even been found neceffary for an
affiflant to make any prefTure, as is frequent-
ly pradifed with the palms of his hands.
But if powerful ccmpreflions fliould here-
after appear expedient upon the ftumps of
patients of fanguine conftitutions, no da-
mage will enfue, provided the circular ban-
dages are not too much tightenedj and even
in thefe cafes the fpunge will claim the
preference over the needle and ligature.
Whenever a ftrong compreffion is found

necefliry

[51 ]

neceffary after amputation, either above the
knee or above the elbow, it will bed: be
made by a fcrew-inftrument, fixed to the
end of the flump, and properly fecured by
bandages. In both thefe cafes, thefe ftraps
muft be brought up over the (houlders ; but
after amputations, either below the elbow,
or the knee, fufficient prefTure may be made
by the double-headed bandage, in the man-
ner defcribed by M. Pouteau, in his Me-
langes de Chirurgie, p. 355.

Thefe flrong com.preffions will but fel-
dom be found neceffary where the tourni-
quet-ligature is made ufe of. If it jfliould
appear otherwife, it will not be requifite to
continue them longer than a fingle night,
as the fpunge will by that time have fecured
itfelf fo effeclually, as not to ftand in need of
any affiftance.

Dr. Stork * has affirmed that it is of per-
nicious, and often indeed of fatal confe-
quence, to cover the whole wound wath
agaric. In regard to the fpunge, the dired:
contrary is true. I have frequently covered

* hihellus fecundus, p. 135.

H 2 the

[ 52 ]

the whole wound with it, and, if I am nol
tpo much prejudiced in its favour to judge
.impartially, have always found that a
wound looks clearer and freflier after this^
than after any other application.

The rules, of which I would recommend
the obfervance, are the follov^ing.

To chufe fuch fpunges as are clofe, corn-
pad, and not ragged. Either to keep thern
dry in fome place near the fire, or to dry
them moderately before the fire, but not to
fuch a degree as to deftroy their power of
expanfion. As fpunges grow from roots
Jlratum fuper Jiratum^ they fhould not be
cut horizontally, in fuch a rnanner as to fe-
parate the lays, but perpendicularly through
the lays, fo that every layer may be cut
through.

Before the application of the dried fpunge,
the wound mufi: be cleared from grumous
blood, and wiped as clean as pofiible with
a fpunge prepared out of warm water.

If the divided artery be large, the infide
of dry fpunge, cut to the moft convenient

fi?e.

[53 ]

fize,mufl: be applied ; and after amputations,
or other wounds where the tourniquet can
be made ufe of, that inftrument fhould be
kept tight during the time of cleaniing the
wound, of applying the fpungc, and for ten,
fifteen or twenty minutes afterwards. The
tourniquet which I would recommend is
the fcrew one, either that of Frcke or Petit ;
both of which, as they do not totally pre-
vent the circulations being carried on in the
fmall collateral branches, are preferable to
the common tourniquet-ligature. I would
alfo advife the placing of a bolfter upon the
principal artery, previous to the fixing of
the tourniquet, as by that means the tour-
niquet will acquire a greater power upon
the vefTel with a fmaller degree of tight-
nefs.

A gentle compreflion mufl be made up-
on the fpunge, either with a linen roller, or
with crofs flips of good flicking plaifler.

If the wound happens to be in a place
where the tourniquet cannot advantageouf-
ly be ufed, as was the cafe of the firfl pa-
tient upon whom I ufed the fpunge, the
fpungc mufl be prelTcd tight into the

wound,

[ 54 ]
wound, a comprefs of linen placed over it,
and it muft be fecured by fuch a roller as
will make a powerful preffurej obferving
at the fame time to keep the patient very
cool. Upon the fmaller arteries it will be
fufficient to ufe the outfide of undried
fpunge, retained by a bandage of moderate
tightnefs.

After amputations below the knee it will
be proper to cut through the interoffeal li-
gament about one-third of an inch, for the
reafons given in Cafe X.

If at any time after the application of the
fpunge, the wound flhould bleed again, but
in no greater quantity than jufl to wet
through the dreffings and the roller, very
little regard ought to be paid to it, even the
tourniquet itfelf fliould not be tightened :
For, in fuch a cafe, as the blood may be
only venal, the tightening of the tourniquet
would probably be the means to increafe it.
If the wound fliould bleed afrefh, fo much
as to give reafon to fufpedt that the blood
proceeds from an artery, the tourniquet
fhould be immediately tightened. I would
not, however, advife a ftronger compreflion

on

lS5]

on the fpunge j but as it may be fuppofed
to be fully faturated with blood, and there-
fore unlikely to flop the hemorrhage, I
would apply a frefli piece, and retain it by
fuch a degree of compreffion as the emer-
gency may render necelTary.

At every dreffing fmall pieces of lint
fhould be placed under the edges of the
fpunge, to facilitate its removal; and when it
is intended to be taken away, it fhould be
done by taking hold of its end, and pulling
it off, as you would a common flicking
plaifter.

The fpunges fhould not be permitted to
remain on longer than ten, twelve, or four-
teen days at mofl, after their application.

If the fmallefl portion of any of them
fhould adhere fo clofely to the wound as
not to be removed by gentler methods,
it ought immediately to be touched with
fome liquid cauftic. This cauflic, however,
w^ili be unnecefTary where the fpunge is cut
according to the direftions given above.

Manchefter,
February 4, 1762*

Boston Medical Library
in the Francis A. Countway
Library of Medicine -Boston

COUNT WAY LIBRARY OF MEDICINE

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